Status seizure

Neuromuscular blockade is an important maneuver if standard measures aren't working. It doesn't stop the seizure of course, but it reduces oxygen consumption, hypercarbia, temperature, and the possibility of complications such as rhabdomyolysis.

If you do intubate a seizure, they need to go to a capable facility with a real ICU and neurology service, and it is critically important that the receiving ED physician understands that you tubed them BECAUSE of seizures refractory to your benzos. Don't let anything get lost in translation.
 
One you have paralyzed them the only way to know if they are still seizing is to put on an EEG. For the reasons Remi gave, RSI is not a bad idea just understand you are not truly stopping the seizure activity. I would use short acting meds. In a case of hyponatremia it is nice to know if your hypertonic saline is working and from a practical standpoint the only way to do that is to see if they are shaking. Getting an EEG takes a while, if the hospital even has one.
 
On a side note, we just got a group of Epileptologists at our hospital and we now do continuous EEGs in the Unit. Pretty cool stuff. It is awesome when you can see the effect of your interventions.
 
When I was in nursing school, I did my preceptorship time on a neurocare floor. It's not an ICU by any means but it does very much specialize in seizures. Four of those beds have the capability of having continuous EEG along with either tele-med or an in-house neurologist (just depends where the doc is at the time). We could see the real-time EEG, which was recorded along with in-room AV recording and we actually attempted to drive patients to seize. We've caught many pseudo-seizures that way... In any event, one of the takeaways from that experience is that it's possible to make basically everyone have seizures. One other "benefit" of that experience is that seizures aren't that scary to me when/if my patient seizes.

Yeah, it is very cool to see the effect of your interventions!
 
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