Certain general measures should be taken for any seizure patient. A patent airway must be assured and vital signs should stabilized. Initial interventions should include an IV, oxygen, pulse oximetry, bedside glucose determination, and a cardiac monitor, if warranted. Intubation should be considered for prolonged seizures, persons that require GI decontamination, and patients who may need to be transferred off-site. In and of themselves, simple seizures do not usually warrant intubation. Standard measures for management of any unconscious patient should be employed. The likelihood of trauma should be assessed. Care should be taken to identify and treat any underlying metabolic disorder.

The first objective is to make an accurate diagnosis; only in patients with status epilepticus is it necessary to initiate specific treatment before diagnostic evaluation has been completed.

Specific management is reviewed of these four clinical situations: the patient who is actively seizing; the patient with previous epilepsy who has a seizure; the patient with a first seizure; and status epilepticus.

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