CP Flow
Monitoring
Support Tool

Status Epilepticus Monitoring Guide

Patient monitoring and complication prevention during intensive care

Patient Type Selection

Continuous EEG (cEEG) Required

Continuous EEG monitoring is mandatory during third-line treatment (anesthetic use). Continue cEEG monitoring for at least 24 hours after seizure control.

Continuous EEG (cEEG)

Critical

Essential monitoring during third-line treatment and anesthetic use

cEEG Initiation

Description

Start immediately upon anesthetic administration

Frequency

Continuous

Critical Note

Mandatory for third-line treatment

Complications to Watch

  • Failure to detect ongoing seizures
  • Excessive sedation

EEG Target Setting

Description

Seizure suppression or burst-suppression pattern

Frequency

At treatment initiation

Critical Note

Clear target setting required

Complications to Watch

  • Inappropriate sedation depth

Seizure Activity Detection

Description

Clinical and electrographic seizure monitoring

Frequency

Continuous

Critical Note

Don't miss non-convulsive seizures

Complications to Watch

  • Covert seizure persistence

Post-sedation Monitoring

Description

Continue cEEG for 24 hours after seizure control

Frequency

Minimum 24 hours

Critical Note

Risk of recurrence with early discontinuation

Complications to Watch

  • Early recurrence

Hemodynamic Monitoring

Critical

Circulatory stability and organ perfusion assessment

Blood Pressure Monitoring

Description

Continuous arterial pressure or frequent non-invasive measurement

Frequency

Continuous or every 5 minutes

Critical Note

Watch for anesthetic-induced hypotension

Complications to Watch

  • Hypotensive brain injury
  • Organ hypoperfusion

Electrocardiogram

Description

Arrhythmia and myocardial ischemia detection

Frequency

Continuous

Critical Note

Especially important with phenytoin use

Complications to Watch

  • Arrhythmia
  • Cardiac arrest

Central Venous Pressure (CVP)

Description

Intravascular volume status assessment

Frequency

Continuous (ICU)

Critical Note

Fluid management guidance

Complications to Watch

  • Volume overload
  • Pulmonary edema

Urine Output

Description

Renal perfusion and function assessment

Frequency

Hourly

Critical Note

Maintain minimum 0.5ml/kg/hr

Complications to Watch

  • Acute kidney injury

Respiratory Monitoring

Critical

Airway and ventilation status assessment

Mechanical Ventilation Monitoring

Description

Tidal volume, pressure, oxygenation monitoring

Frequency

Continuous

Critical Note

Immediate intubation when needed

Complications to Watch

  • Respiratory failure
  • Hypoxemia

Arterial Blood Gas Analysis

Description

pH, PaCO2, PaO2, lactate measurement

Frequency

Every 6-12 hours

Critical Note

Acid-base balance and ventilation adequacy

Complications to Watch

  • Respiratory acidosis
  • Metabolic acidosis

Oxygen Saturation

Description

Peripheral oxygen saturation monitoring

Frequency

Continuous

Critical Note

Maintain >95%

Complications to Watch

  • Hypoxemia

Airway Pressure

Description

Peak airway pressure and plateau pressure monitoring

Frequency

Continuous

Critical Note

Lung injury prevention

Complications to Watch

  • Barotrauma
  • Pneumothorax

Metabolic and Laboratory Monitoring

High Priority

Metabolic status and drug effect assessment

Electrolytes

Description

Na, K, Cl, Ca, Mg, phosphate

Frequency

Every 12-24 hours

Critical Note

Correct seizure-triggering factors

Complications to Watch

  • Seizure provocation
  • Arrhythmia

Blood Glucose

Description

Blood glucose level monitoring

Frequency

Every 4-6 hours

Critical Note

Target 70-180 mg/dL

Complications to Watch

  • Hypoglycemic seizures
  • Hyperglycemic encephalopathy

Liver Function

Description

AST, ALT, bilirubin, PT/INR

Frequency

Every 24-48 hours

Critical Note

Monitor valproate, phenytoin toxicity

Complications to Watch

  • Hepatotoxicity
  • Coagulopathy

Renal Function

Description

Creatinine, BUN, urine output

Frequency

Daily

Critical Note

Need for drug dose adjustment

Complications to Watch

  • Acute renal failure

Drug Levels

Description

Phenytoin, valproate blood levels

Frequency

As needed

Critical Note

Maintain within therapeutic range

Complications to Watch

  • Toxicity
  • Treatment failure

Neurological Monitoring

High Priority

Consciousness level and neurological change assessment

Consciousness Level

Description

GCS or RASS scale

Frequency

Hourly (during sedation interruption)

Critical Note

Assess after sedation interruption

Complications to Watch

  • Excessive sedation
  • Brain injury

Pupil Response

Description

Pupil size and light reflex

Frequency

Every 4 hours

Critical Note

Signs of increased intracranial pressure

Complications to Watch

  • Increased intracranial pressure
  • Brain herniation

Focal Neurological Signs

Description

Motor and sensory function assessment

Frequency

During sedation interruption

Critical Note

Detect new focal deficits

Complications to Watch

  • Cerebral infarction
  • Hemorrhage

Intracranial Pressure (ICP)

Description

ICP monitoring (when indicated)

Frequency

Continuous

Critical Note

Maintain <20 mmHg

Complications to Watch

  • Increased intracranial pressure
  • Brain death

Infection Monitoring

Moderate

Causative infection and healthcare-associated infection surveillance

Temperature

Description

Fever and hypothermia monitoring

Frequency

Every 4 hours

Critical Note

Suspect infection if >38.5°C

Complications to Watch

  • Sepsis
  • Meningitis

White Blood Cell Count

Description

WBC and differential count

Frequency

Daily

Critical Note

Monitor infection and drug toxicity

Complications to Watch

  • Immunosuppression
  • Bone marrow suppression

Culture Studies

Description

Blood, urine, sputum cultures

Frequency

When febrile

Critical Note

Pathogen identification and sensitivity

Complications to Watch

  • Multidrug-resistant organism infection

Cerebrospinal Fluid Analysis

Description

CSF analysis (when suspected)

Frequency

As needed

Critical Note

Differentiate encephalitis, meningitis

Complications to Watch

  • Central nervous system infection

Monitoring Timeline

Immediate

At Third-line Treatment Initiation

Start cEEG, prepare mechanical ventilation, insert central venous catheter, arterial line

1H

1 Hour After Treatment Start

Initial laboratory tests, arterial blood gas analysis, chest X-ray

6H

Every 6 Hours

Arterial blood gas analysis, electrolyte tests, blood glucose

24H

24 Hours After Seizure Control

Continue cEEG, consider sedation reduction, neurological assessment

Warning: This tool cannot replace clinical judgment by medical professionals and should be used for reference only.

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