General Approach

The initial approach to SE involves first removing the patient from harmful surroundings and ensuring a safe airway to prevent respiratory collapse or aspiration. Benzo-diazepines are the first medications administered, as they are the drugs of choice to stop acute seizure activity, followed by the initiation of an AED. Medications are typically given IV for immediate onset of action, but if no IV access is available, certain medications may be given intramuscularly (IM), rectally, buccally, or via an endo-tracheal tube. Once the seizures stop, clinicians must identify and treat the underlying cause of the seizures, such as toxins, hypoglycemia, or trauma. Patients with known seizure disorders should be evaluated for abrupt cessation of their medications or for history of noncompliance.

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