Seizures: Emergent and Codes

*See the seizure medication table for quick reference.

Seizure overview.

Head trauma:

• Early seizure – within first 7 days, prevent with 5/mg/kg day phenytoin (valproate has higher mortality)
• No prophylaxis for late seizures.

Emergent:

For emergent seizures, benzos are the drug of choice to stop seizing.

• Lorazepam – onset 2-3 minutes, 0.1 mg/kg up to 4 mg every 5-10 minutes.
• Diazepam – onset rapid, but duration is short.  0.15/mg/kg up to 10 mg every 5 minutes.
• Midazolam – 0.2 mg/kg up to 10 mg/dose

After benzos, start control med:

• Phenytoin 20 mg/kg
• Fosphenytoin
• Phenobarbital 20 mg/kg
• Valproic Acid 20-40 mg/kg
• Levetiracetam 20-30 mg/kg
• Lacosamide 200-400 over 15 minutes

If refractory to above:

1. Phenobarbital 5-15 mg/kg over 15 minutes then 0.5 mg/kg/hr
2. Thiopental 2-7 mg/kg then 0.5 mg/kg/hr
3. Midazolam 0.2 mg/kg then 0.5 mg/kg/hr
4. Propofol 1-2 mg/kg then 20-200 mcg/kg/min

*******No Valproic Acid in potentially pregnant patients***********

Also avoid: phenytoin, carbamazepine, and phenobabital, but not as severely.  Try to use a single agent.