Seizures and Status Epilepticus: Diagnosis and Management in the Emergency Department

Shearer, Peter MD
Park, David MD
Bowman, Andrew J. RN, BSN, CEN, CTRN, CCRN-CMC, BC, CVN-I, NREMT-P
Huff, Stephen J. MD

¹Authors
²Assistant Professor and Residency Director, Department of Emergency Medicine, Mount Sinai School of Medicine, New York
³Senior Resident, Mount Sinai School of Medicine, Department of Emergency Medicine, New York
⁴Peer Reviewers
⁵Patient Care Coordinator Education Coordinator Home Hospital Campus Greater Lafayette Health Services, Inc., Lafayette, IN
⁶Associate Professor of Emergency Medicine and Neurology University of Virginia Health System

Date of original release: August 10, 2006.

Date of most recent review: August 5, 2006.

See “Physician CME Information” on back page.

Emergency Medicine Practice 8(8):p 1-31, August 2006.

It's midnight and you are considering going on diversion. A 24-year-old graduate student with no past medical history is brought in by EMS having had a witnessed “seizure” while studying in the library. According to his roommate, he had been pulling a string of “all nighters” studying for midterms and drinking large amounts of coffee in order to stay awake. There are no beds inhouse, the ED is packed, and the CT backed up. The patient looks great and has a normal physical exam, and he wants to go home. While trying to decide if any tests or neuroimaging are needed, the patient has another tonic-clonic event immediately followed by a third event which 10 mg of lorazepam fails to stop. You begin an infusion of 1800 mg of phenytoin and contact the neurologist on call only to find out that he is a headache specialist who has not managed a case of status epilepticus since leaving residency twenty years prior. You keep thinking, “What if I had sent this kid home; would I have been negligent?” More immediate, you wonder, “What am I going to do if phenytoin does not stop the seizure?”