Seizures (2014)

  • Inclusion: Adult ≥ 18 with generalized convulsive seizures
  • Exclusion:
    • Pediatrics
    • Complex partial seizures
    • Acute head trauma
    • Multi-system trauma
    • Brain mass or tumor
    • Immunocompromised patients
    • Eclampsia.
  • Level A:
    • Administer additional antiepileptic medication in refractory status epilepticus who have failed treatment with BZDs
  • Level B:
    • Administer IV phenytoin, fosphenytoin, or valproate in refractory status epilepticus who have failed BZD
  • Level C:
    • EP need not initiate antiepileptic medication in ED for 1st time provoked seizure. Identify and treat precipitating medical conditions.
    • EP need not initiate antiepileptic medication in ED for 1st time unprovoked seizure with out evidence of brain disease or injury.
    • EP may initiate antiepileptic medication in ED or defer in coordination with other providers, for patients who experienced 1st unprovoked seizure w a remote history of brain disease or injury.
    • Do not need to admit patients with 1st unprovoked seizure who have returned to clinical baseline in Ed.
    • When resuming antiepileptic medication in ED is deemed appropriate, EP may administer IV or oral medication at their discretion.
    • Administer IV levitiracetam, propofol or barbiturates in refractory status epilepticus who failed BZD

ACEP Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med. 2014;63:437-447 PDF

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