Time (mins) Intervention
0 Airway, breathing, circulation
  History
  Trauma survey
  Oxygen
  Establish IV access
5 Send blood sample for lab tests
  Thiamine 100 mg IV Dextrose 50%, 50 mL IV
  Naloxone 2 mg IV (if indicated by history)
10 Benzodiazepines: lorazepam 2 gm IV q 5 min (may be earlier, if possible)
  Phenytoin load 20 mg/kg, or fosphenytoin
30 Phenobarbital or benzodiazepine infusion (midazolam or diazepam)
  EEG monitoring (if not yet begun)
60 Pentobarbital coma Table: Pentobarbital-Induced Anesthesia
80 General anesthesia, neuromuscular blockade

Table adapted from B Litt, GL Krauss. Pharmacologic Approach to the Acute Seizure Patient. In B Chernow (ed), Pharmacologic Approach to the Critically Ill Patient (2nd ed). Baltimore: Williams & Wilkins, 1988;484-506.

Authored By: 
Brian Litt MD
Gregory L Krauss MD
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Reviewed By: 
Steven C. Schachter MD
on: 
Saturday, May 1, 2004