Version July 2025
| Evaluation |
| Vital signs and general examination |
| Neurologic examination and GCS |
| Screening laboratories (CBC, glucose, electrolytes, BUN, creatinine, PT, PTT, ABG, LFTs, drug screen) |
| ECG |
| Head CT scan: prioritize emergent if focal neurologic signs, papilledema, fever |
| Lumbar puncture: prioritize emergent after CT scan if fever, elevated WBC, meningismus; otherwise do according to level of suspicion for diagnosis or if cause remains obscure |
| EEG: for possible nonconvulsive seizure, or if diagnosis remains obscure |
| Other laboratory tests: blood cultures, adrenal and thyroid tests, coagulation tests, carboxyhemoglobin, specific drug concentrations – do according to level of suspicion for diagnosis or if cause remains obscure |
| Brain MRI with DWI, if cause remains obscure |
| Management |
ABCs:
|
| Glucose 50% IV 50 mL (after blood drawn, before results back) |
| Thiamine 100 mg IV |
| Treat definite seizures with phenytoin or equivalent |
Consider empiric treatments:
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