A fictional 42-year-old continues to have generalised convulsive activity five minutes after a seizure began, without recovering consciousness.
Frame the danger first.
- A convulsive seizure lasting five minutes or more requires emergency treatment as status epilepticus.
- Establish timing, look for an immediately available individual emergency plan and identify reversible causes.
- Persistent impaired consciousness may represent ongoing non-convulsive seizure activity or another complication.
Act, escalate, reassess.
- Call for emergency help, protect the patient from injury and begin ABCDE resuscitation.
- Check glucose and treat reversible causes while following the current local status epilepticus algorithm.
- Give protocol-directed first-line treatment promptly, record exact times and prepare the next stage before failure is declared.
- Escalate after initial treatment failure and involve anaesthesia/critical care early when refractory disease is possible.
Red flags that change pace.
- Airway compromise, hypoxia, hypotension or significant injury
- Failure to stop after protocol first-line treatment
- Pregnancy, poisoning, metabolic disturbance, infection or concern for raised intracranial pressure
What makes care less safe.
- Losing track of seizure and treatment times
- Repeating early treatment without preparing second-line and airway support
- Failing to consider hypoglycaemia, eclampsia, alcohol withdrawal or non-adherence
Say the concern plainly.
Convulsive status began at [time]. ABCDE findings are [summary]; glucose is [result]. Protocol treatments and exact times are [list]. Seizure activity is [ongoing/stopped], and I need expert help for the next treatment and airway plan.