373 Ch 372. Status Epilepticus

Status epilepticus (SE) = (1) seizure ≥ 5 min, OR (2) ≥ 2 seizures without recovery in between (ILAE 2015 operational definition for convulsive SE)；categories: convulsive SE (CSE — GTC) vs non-convulsive SE (NCSE — subtle motor or pure altered LOC); focal SE (with or without impaired awareness)；etiology: low ASM levels (subtherapeutic, missed doses), withdrawal (alcohol, BZD), CNS infection, stroke, TBI, metabolic (hyponatremia, hypoglycemia), drug toxicity, autoimmune encephalitis；mortality 10-20% overall (higher in elderly, refractory)；STAGED TREATMENT: (1) Initial 0-5 min — ABC + glucose + thiamine + IV access; (2) 5-20 min: First-line BZD — IV lorazepam 4 mg or diazepam 10 mg; IM midazolam 10 mg; (3) 20-40 min: Second-line ASM — ESETT 2019: fosphenytoin, valproate, levetiracetam comparable ~ 50% efficacy each; (4) > 40 min: Refractory SE — IV anesthetic (midazolam, propofol, ketamine) + cEEG + intubation；super-refractory SE > 24 hr：multiple agents + ketogenic + immunotherapy。