Ep 213 Update in Management of Status Epilepticus

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 10 February 2026

⏱️ 59 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Convulsive status epilepticus is one of the most morbid neurologic emergencies we manage in the ED, and outcomes depend far more on speed than drug selection. Like ventricular fibrillation, each minute of ongoing convulsions worsens hypoxia, acidosis, cardiovascular instability, and neuronal injury, while making seizures progressively harder to terminate. Modern definitions are intentionally time-compressed to force early, parallel, clock-anchored action. Any patient still convulsing when you reach the bedside should be treated as evolving status epilepticus. In this EM Cases podcast with Dr. Sara Gray, we take a practical, time-based approach to convulsive status epilepticus, focusing on early, adequately dosed benzodiazepines, avoiding common escalation and dosing pitfalls, anticipating post-ictal cardiovascular collapse, and knowing when to escalate to second-line agents, airway control, and anesthetic-dose therapy. We also address the transition to non-convulsive status epilepticus and how to recognize ongoing seizures when EEG is not immediately available. We answer questions such as: Why does time to first benzodiazepine matter more than the drug or route? What critical actions should occur in parallel with the first dose? What are 3 key actions to do in parallel with the first benzodiazepine? Why is underdosing second-line antiseizure medications—especially levetiracetam—a common and dangerous pitfall? When should persistent seizures trigger intubation and anesthetic-dose therapy? How can we identify non-convulsive status epilepticus once tonic-clonic activity stops? And many more (we also include a high yield status epilepticus management algorithm in the show notes!)... If you find EM Cases helpful in your clinical practice, please consider supporting our work so we can continue producing free, high-quality emergency medicine education for clinicians around the world. Make a donation here: https://emergencymedicinecases.com/donation/

Transcript

Click on a timestamp to play from that location

0:00.0	Welcome to the Emergency Medicine Cases Podcasts. I'm your host, Dr. Anton Hellman, bringing you the brightest minds in emergency medicine from around the world. EMCases is brought to you by Shremi, the Schwartz-Riesman Emergency Medicine Institute. That's a non-profit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physicians.
0:24.3	First, just a quick word from our sponsor Metricade, the experts in complex physician scheduling since 2012.
0:30.9	I've been using Metricade's incredible scheduling system for more than a decade, and it's been a game changer for me and my colleagues.
0:37.8	Shift work comes with its challenges, but Metricade helps minimize the drawbacks by ensuring
0:42.2	fair distribution of shifts while integrating circadian rhythm-friendly recovery time into its
0:47.8	methodology, preserving your precious sleep so that you can perform at your best.
0:52.8	Go to metricade.com slash EM cases to see how Metricade can
0:56.9	make your scheduling fair, improve your sleep, and your performance. That's metricade.com
1:02.7	slash EMC-A-S-E-S. And now a word from one of our sponsors, Paratus, the all-new emergency
1:10.2	assistant. Paratus combines everything all-new emergency assistant.
1:17.4	Paratus combines everything you loved about easy recess with powerful upgrades, just-in-time procedural guidance, stress-proof organization, and Adams, the intelligent assistant that
1:23.3	helps you find exactly what you need.
1:25.7	Whether you're in the ER, on transport, or in the field,
1:29.0	Parratus keeps you ready for anything. Learn more and start your free trial today at paredesmedical.com
1:35.2	slash EM cases. That's P-A-R-A-T-U-S medical.com slash EM cases.
1:43.1	Status Epileptyches remains one of the most time-critical emergencies we face.
1:48.0	Prolong seizures can lead to severe acidosis causing cardiovascular collapse and CNS damage.
1:55.0	Time-based definitions have shortened in the last decade or so.
1:59.6	Mortality remains high, and our seizure, cessation,
2:03.2	airway, and sedation strategies are evolving. So it's time for an update. If you haven't
2:09.9	listened to our big main episode podcast on status epilepticus already, episode number 133,
2:15.4	I encourage you to do so. It's one of my personal faves.
	...

Please login to see the full transcript.

Previous episode | Next episode

Disclaimer: The podcast and artwork embedded on this page are from Dr. Anton Helman, and are the property of its owner and not affiliated with or endorsed by Tapesearch.

Generated transcripts are the property of Dr. Anton Helman and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.