A seizure past five minutes = status epilepticus: full-dose benzodiazepine then a second-line agent without hesitation.
Refractory status epilepticus
Every extra minute of seizing worsens neuronal injury and drug resistance.
A lethal cause behind the seizure
Hypoglycemia, intracranial bleed, meningitis, eclampsia, poisoning.
Non-convulsive status
No recovery after movements stop? Consider it and request EEG.
Most seizures self-terminate within two minutes — past five they rarely stop alone.
Afterwards document onset, duration, limbs involved, and recovery pattern.
IM midazolam is the prehospital first choice when no IV access.
Brief jerks after collapse, rapid recovery.
Resisted eye closure, waxing asynchronous movements.
Pregnancy + hypertension + proteinuria — magnesium is the treatment.
| Drug | Dose | Route | Notes |
|---|---|---|---|
| Lorazepam⚠ Critical | 4 mg IV | IV | Repeat once after 5–10 min |
| Midazolam⚠ Critical | 10 mg IM | IM | When no IV access |
| Levetiracetam | 60 mg/kg (max 4.5 g) | IV infusion | Second line |
Teaching examples — subject to clinical review and local protocol.
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This content is an educational reference and does not replace clinical judgement or local protocols.
