Status epilepticus starts at 5 minutes. Give benzos early. Always check glucose.
Steps by Cert Level
ALL: Protect patient from injury. Do NOT restrain forcefully. Do NOT put anything in mouth. Time the seizure. BGL check mandatory.
ALL: Post-ictal: reassess airway, vitals, BGL. Rule out head injury, stroke, hypoglycemia, eclampsia.
AEMT: Status epilepticus (>5min or no recovery between): Midazolam 5mg IM/IN or 2.5mg IV/IO. OR Lorazepam 2mg IV/IO q5min (max 4mg). OR Diazepam 5mg IV/IO q5min (max 20mg).
PARAMEDIC: If benzos fail: Levetiracetam 1000–3000mg IV over 15min. Phenobarbital 15–20mg/kg IV. Intubation + RSI if seizure uncontrolled. Eclampsia: Magnesium sulfate 4–6g IV over 15–20min.