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    Seizure (beta)

    Official guideline from the American College of Emergency Physicians.

    Summary by Eric Steinberg, DO
    Strength
    Level A
    Level B
    Level C

    Recommendations

    Anti-Epileptic Drugs (AEDs) for First-Time Seizure
    1. Emergency physicians need not initiate antiepileptic medication* in the emergency department for patients who have had a first provoked seizure. Precipitating medical conditions should be identified and treated. *Antiepileptic medication in this document refers to medications prescribed for seizure prevention.
    2. Emergency physicians need not initiate antiepileptic medication* in the emergency department for patients who have had a first unprovoked seizure without evidence of brain disease or injury. *Antiepileptic medication in this document refers to medications prescribed for seizure prevention.
    3. Emergency physicians may initiate antiepileptic medication* in the emergency department, or defer in coordination with other providers, for patients who experienced a first unprovoked seizure with a remote history of brain disease or injury. *Antiepileptic medication in this document refers to medications prescribed for seizure prevention.
    Disposition
    1. Emergency physicians need not admit patients with a first unprovoked seizure who have returned to their clinical baseline in the emergency department.
    AED Route of Administration
    1. When resuming antiepileptic medication in the emergency department is deemed appropriate, the emergency physician may administer intravenous (IV) or oral medication at their discretion.
    What do the icons mean?  
    Research PaperHuff JS, Melnick ER, Tomaszewski CA, et al. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Seizures. Ann Emerg Med. 2014;63(4):437-47.e15.