Status Epilepticus Clock: Five Minutes, Twenty, Forty
Almost no tonic-clonic seizure that has run for five minutes will stop on its own, and the benzodiazepine receptors you are aiming at are internalised within minutes — so a drug that works beautifully at four minutes may fail at forty. Run the timed algorithm against the clock, then check the phenytoin order that pharmacy just sent up, then match each maintenance drug to the finding that gives it away.
1042 — Mrs Delgado, 58, 82 kg, room 412Known epilepsy on levetiracetam; her doses have been held since midnight for a colonoscopy and no intravenous cover was ordered. She is in a generalized tonic-clonic seizure and it is not stopping. Tap the actions in order, earliest first. Five options in this list are wrong at any time on this clock.
Tap what you do next
Check the order before you hang itThe pearl on this drug is not decoration — a phenytoin infusion given too fast, or in the wrong fluid, causes hypotension and asystole. Build the order below and the desk will tell you what is safe, what is unsafe, and what it would take to fix it.
Try the order exactly as the chapter describes it — phenytoin 1000 mg in 5% dextrose over 10 minutes — then fix one field at a time and watch which flags clear.
One finding, one drug, one actionNearly every antiseizure drug does one of three things: block voltage-gated sodium channels, enhance GABA-mediated inhibition, or reduce glutamate release and calcium entry. Group them that way and the adverse effects stop being a list to memorise. Read the finding and name the drug behind it.
Item 1
The clock, and what is due when
Weight-based doses for this patient
Maximums are capped in the readout. Under-dosing is the commonest error in status epilepticus — two milligrams of lorazepam given once is not a treated patient.