Status epilepticus is currently defined as a grand mal or tonic clonic seizure lasting 5 minutes or more, two or more seizures without regaining consciousness or having repeated seizures for 30 minutes or more. Previously, definitions required one to last approximately 20 minutes or more to be classified as status epilepticus. A typical seizure will last 1-2 minutes in the tonic-clonic phase.
Seizures can be caused by genetic and congenital conditions, head trauma, tumors, infection, stroke, medication issues, low blood sugar and other metabolic issues. In children, fever is a very common cause. Epilepsy is defined as: at least two unprovoked seizures that occur more than 24 hours apart OR a high likelihood that a person will have additional seizures over the next 10 years after one unprovoked seizure. Here is a link to the Epilepsy Foundation for information on the many types of seizures and conditions that can cause seizures. http://www.epilepsy.com/
Seizures vary in their appearance. They can range from a momentary loss of attention that is hard to spot to a convulsion. Patients rarely need much intervention when having a seizure and usually recover without medical intervention. If the patient becomes injured during the seizure, has status epilepticus or other triggers specific to the individual patient, 911 may be contacted. Status epilepticus is considered a medical emergency.
To treat a status epilepticus patient, providers should first protect the patient from injury by gently supporting the patients head and removing objects around them. Obtain the time the seizure started and track how long it lasts. Monitor the patients airway but do not put anything in their mouth while they are still seizing. Do not forcibly hold the patient down. EMS providers should obtain glucometry and treat appropriately. If the patient is still in a status seizure, Ativan 2mg IV/IM (adults) should be administered. An option is Versed 5mg IN. The doses can be repeated once on standing order is the seizures continue. Vitals signs and pulse oximetry should be monitored.
When documenting, if the seizure meets status epilepticus criteria, please select a primary or secondary impression of “status epilepticus”.