Management

**Equivalent Corticosteroid Doses**
Quick reference guide for corticosteroid comparison
Generic Steroid	Equivalent dose (mg)	Anti-inflammatory Potency	Mineralocorticoid potency	Oral dosing forms (tablet in mg)	Duration of Action (hours)
Cortisone	25	0.8	0.8	tab: 25	8-12
Hydrocortisone	20	1	1	tab: 5, 10, 20	8-12
Prednisone	5	4	0.8	tab: 1, 2.5, 5, 10, 20, 50	12-36
Prednisolone	5	4	0.8	tab: 10, 15, 30	12-36
Methylprednisolone	4	5	0.5	tab: 4, 8, 16, 32	12-36
Dexamethasone	0.75	30	0	tab: 0.5, 0.75, 1, 1.5, 2, 4, 6	36-54
Betamethasone	0.6	30	0	solution: 0.6mg/5ml (118mL)	36-54
Fludrocortisone	-	15	150	tab: 0.1mg	24-36
Potencies are reported relative to hydrocortisone Steroid doses are listed for equivalent glucocorticoid PO / IV doses (IM may differ)

**Initial Steps for Status Epilepticus Therapy (Adult)**
AED Step	Description
1^stLine	Lorazepam 0.1mg/kg IV @ <2mg/min
2^nd Line	Give either simultaneously with above or 1 minute after lorazepam infusion completes: phenytoin 20mg/kg IV @ <50mg/min phosphenytoin 20mg/kg IV @ <150mg/min
3^rd Line	7% chance of success at stopping seizure: phenobarbital <20mg/kg IV @ <100mg/min valproate 15-30mg/kg IV @ <6mg/kg/min levetiracetam 20mg/kg IV in 15min
Consider: skip 3^rd line → intubate → start midazolam, pentobarbital or propofol

**Management of Acute Increase in Intracranial Pressure**
Step	Description
1	Check airway
2	Elevate head of the bed to 30^o
3	Osmotic therapy with mannitol 1gm/kg IV or 10-20ml of 23.4% saline Skip if hypotensive, volume depleted, serum osmolality >320mOsm/L
4	If resistant / sudden IC-HTN is present → STAT non-contrast head CT
5	Drain 3-5ml of CSF if intraventricular catheter is present
6	Ensure patient is sedated and paralyzed
7	Hyperventilation with bag valve mask (to PaCO2 30-35mmHg)
8	Induced coma with pentobarbital 100mg IV or thiopental 2.5mg/kg IV

**Stroke Management Timeline**
Time (Hours from symptom onset)	IV tPA	IA tPA (Consider after IV tPA failure)	Mechanical Embolectomy (Consider after IV tPA failure)
1	✓	✓	✓
2	✓	✓	✓
3	✓	✓	✓
4	✓	✓	✓
5	Up to 4.5hr	✓	✓
6	-	✓	✓	Verify perfusion prior to procedure
7	-	-	✓
8	-	-	✓
>9	-	-	-