Generalized convulsive activity >5mins or repeated seizure without full recovery

ABC – O2 early as seizure prevents effective respirations

Frost Line: Lorazepam or Midazolam 0.1mg/kg. Yes it’s a big dose but better to snow them than allow prolonged seizure. Max dose 8mg. Repeat @5min.

Second Line: Levetiracetum 60mg/kg (max 4500mg). Phenobarbital 20mg/kg. Valproic Acid 40mg/kg (max 3000mg)

Probably intubating at this point (15-20mins) Propofol 1.5mg/kg and Ketamine 2mg/kg and Paralytic

Neuroimaging especially if focal seizure

POC Electrolytes and Glucose – 150ml 3% Hypertonic Saline or 2 Amps Bicarbonate

Immediately start Propofol drip (3-5mg/kg/hr) or Midazolam drip