Seizures and Epilepsy - Emergency Department
This section summarises ED assessment and management of seizures with emphasis on status epilepticus (SE). Key guideline anchors: NICE NG217 (adults and children) for definitions and escalation; Resuscitation Council UK (paediatric algorithms and weight‑based dosing); RCEM standards for ED process and documentation; GOV.UK for driving/DVLA advice.
Definitions and why speed matters
- Seizure: transient clinical signs or symptoms resulting from abnormal synchronous neuronal activity.
- Status epilepticus (SE): ongoing seizure activity or recurrent seizures without recovery between events. Treat a convulsive seizure once it has lasted ≥5 minutes (NICE NG217).
- Refractory SE: persistent seizures despite first‑ and second‑line treatments; usually requires ICU/anaesthetic escalation.
- Convulsive SE (CSE): obvious tonic‑clonic motor activity with impaired consciousness.
- Non‑convulsive SE (NCSE): electrographic seizure activity with little or no motor signs - requires EEG to confirm.
Prompt treatment matters because the probability that benzodiazepines will stop seizures declines with time and prolonged seizures increase metabolic stress and neuronal injury (NICE NG217).
Initial ED priorities (first minutes)
1. Airway, Breathing, Circulation (ABCs): protect the airway, support breathing and circulation, and provide high‑flow oxygen if available. Be ready to secure the airway. 2. Time the seizure: record onset and any changes; timing is critical for management and documentation. 3.
Check and treat blood glucose immediately; give IV dextrose if hypoglycaemic. 4. Establish IV access;...