NeurologyEmergency Medicine
Adult Convulsive Status Epilepticus
NICE NG217 / RCEM — staged escalation: benzodiazepine, second benzodiazepine, levetiracetam/phenytoin, anaesthesia.
Source: NICE NG217; RCEM 2022
Used in: Seizures & Epilepsy
Step 1 of ~5
info
Recognise + ABCDE
Convulsive status = continuous seizure ≥5 min OR recurrent without recovery. Protect airway, recovery position, high-flow O₂, IV/IO access, check CBG (treat if <4 with 200 mL 10% glucose), thiamine 200 mg IV if alcohol/malnourished, monitor. Bloods: glucose, U&E, calcium, magnesium, FBC, AED levels, toxicology, ABG, lactate.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Phenytoin / Fosphenytoin · Antiepileptic — Status Epilepticus (Second-Line)
- Levetiracetam (IV) · Antiepileptic — Status Epilepticus (Second-Line)
- Levetiracetam IV (Status Epilepticus) · Antiepileptic — Second-Line Status Epilepticus
- Diazepam (Paediatric) · Benzodiazepine — Status Epilepticus / Febrile Convulsions (Community)
- Midazolam (Paediatric) · Benzodiazepine — Status Epilepticus (First-Line) / Procedural Sedation
- Ketamine (Anaesthesia/Sedation) · Dissociative Anaesthetic (NMDA Receptor Antagonist)
Pathways
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Featured in these MRCEM clinical pathways
A deeper exam-focused version of this pathway is available on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only. Always apply local guidelines and clinical judgement.