Take a deeper dive into our peer-reviewed emergency medicine content with the EMplify podcast. Join hosts Sam Ashoo, MD and T.R. Eckler, MD for educational, conversational reviews of current evidence guaranteed to help you make your best clinical decisions. Each high-yield episode gives you practical, time-tested guidance from practicing emergency medicine clinicians and subject-matter experts. Listen and learn!
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Take a deeper dive into our peer-reviewed emergency medicine content with the EMplify podcast. Join hosts Sam Ashoo, MD and T.R. Eckler, MD for educational, conversational reviews of current evidence guaranteed to help you make your best clinical decisions. Each high-yield episode gives you practical, time-tested guidance from practicing emergency medicine clinicians and subject-matter experts. Listen and learn!
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Status Epilepticus Topic Introduction* Focus: Status Epilepticus in Adults* Reference to recent pediatric episode* Article authors: Dr. Marquez, Dr. Kaur, Dr. LayWhy Status Epilepticus Matters* Teaching value and clinical challenge* Team-based care and multidisciplinary involvementGuidelines and Evidence* Review of major guidelines (International League Against Epilepsy, Neurocritical Care Society, American Epilepsy Society)* Key trials: EcLiPSE, ConSEPT, ESETT* Updated definition of status epilepticusClassification and Diagnosis* Convulsive vs. non-convulsive status* Importance of repeated neurologic exams* Diagnostic challenges and mimics (e.g., syncope, psychogenic seizures)Etiology and Workup* Acute vs. non-acute causes* Common triggers: medication noncompliance, metabolic issues, infections, trauma* Importance of sleep patterns and ammonia levels* The NORSE acronym (new onset refractory status epilepticus)Prehospital and ED Management* Airway, breathing, circulation priorities* Early pharmacologic intervention (IM midazolam preferred in prehospital)* Gathering history and medication information* Positioning and airway protectionDiagnostics* Laboratory workup: glucose, CBC, metabolic panel, drug levels, pregnancy test* Imaging: non-contrast CT, MRI, ultrasound, lumbar puncture* EEG: spot vs. continuous monitoringTreatment Approach* First-line: Benzodiazepines (lorazepam, midazolam)* Second-line: Levetiracetam, valproate, fosphenytoin, phenobarbital, lacosamide* Third-line: Continuous infusions (midazolam, propofol, pentobarbital, thiopental, ketamine)* Dosing pearls and importance of rapid escalationSpecial Populations* Pregnancy (eclampsia: magnesium as first-line)* Substance-induced status epilepticus (e.g., isoniazid toxicity and pyridoxine)* Brief mention of pediatric management and the PD stat appRisk Management Pitfalls* Non-convulsive status is common and easily missed* Importance of weight-based dosing* Need for formal EEG in ambiguous cases* Don’t assume non-adherence is the only cause in known epileptics* Always consider higher level of care for status patientsClinical Pathway* Stepwise approach to medication and escalation* Emphasis on having a pathway/checklist for these high-stress casesConclusion* Recap of key points* Thanks to authors and listeners* Reminder to visit ebmedicine.net for CME and resourcesEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net
EMplify by EB Medicine
Take a deeper dive into our peer-reviewed emergency medicine content with the EMplify podcast. Join hosts Sam Ashoo, MD and T.R. Eckler, MD for educational, conversational reviews of current evidence guaranteed to help you make your best clinical decisions. Each high-yield episode gives you practical, time-tested guidance from practicing emergency medicine clinicians and subject-matter experts. Listen and learn!
