Reference — Critical Care
Seizure Management Reference
Quick bedside reference for seizure classifications, status epilepticus criteria and medication sequence, nursing priorities during a seizure, and postictal assessment.
Educational use only. Status epilepticus is a medical emergency requiring immediate physician-directed care. Follow your institution's seizure and emergency protocols. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Status Epilepticus — Definition
Operational definition (treat at ≥5 minutes):
Seizure lasting ≥5 minutes, OR two or more seizures without return to baseline consciousness between them.
Non-convulsive SE (NCSE) — ongoing seizure activity without visible motor manifestations — can only be diagnosed with continuous EEG.
Seizure Type Summary
| Type | Consciousness | Movement | Postictal |
|---|---|---|---|
| Focal onset aware | Preserved | Focal motor, sensory, autonomic, or psychic symptoms | Minimal or none |
| Focal onset impaired awareness | Impaired | Automatisms (lip smacking, hand picking) | Confusion common |
| Generalized tonic-clonic | Lost | Tonic stiffening → clonic jerking bilaterally | Prolonged confusion, fatigue |
| Absence | Brief impairment | Staring; no motor activity; abrupt onset/offset | None |
| Myoclonic | Usually preserved | Brief bilateral muscle jerks | Minimal |
| Atonic (drop attack) | Brief | Sudden loss of muscle tone, fall | Minimal |
Status Epilepticus — Medication Sequence
| Phase | Medications (per order) | Nursing Action |
|---|---|---|
| First-line (5–10 min) | Lorazepam IV 0.1 mg/kg (max 4 mg) OR diazepam IV/PR OR midazolam IM if no IV access | Administer, monitor airway, prepare second-line |
| Second-line (10–20 min) | Fosphenytoin IV, valproate IV, levetiracetam IV, or phenobarbital IV — per physician order | Give while managing airway; prepare for intubation |
| Refractory SE (>30 min) | Propofol, midazolam, or pentobarbital continuous infusion — per intensivist | Intubate, mechanical ventilation, continuous EEG monitoring required |
Nursing Interventions During a Seizure
| Action | Priority |
|---|---|
| Note seizure start time | Critical |
| Position lateral (recovery position) | High |
| Protect head from hard surfaces | High |
| Do NOT insert objects into mouth | Critical |
| Do NOT forcibly restrain | High |
| Apply oxygen via mask | High |
| Obtain IV access / check glucose | High |
| Observe and document seizure pattern | High |
| Stay with patient; call for help | Critical |
| Notify provider if seizure ≥5 min | Critical |
Postictal Assessment
| Item | Expected / Notes |
|---|---|
| LOC | Confusion, drowsiness, disorientation for 5–60 min |
| Todd's paralysis | Transient unilateral weakness (hours); resolves spontaneously — not stroke |
| Aphasia | Transient if dominant hemisphere involved; resolves |
| Airway | Maintain lateral position until awake — aspiration risk |
| Vitals | Tachycardia, mild HTN, transient hypoxia are common |
| Injuries | Check for tongue lacerations, shoulder dislocation, fractures |
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Society of Critical Care Medicine (SCCM) · Surviving Sepsis Campaign · American Association of Critical-Care Nurses (AACN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →