skip to main content

SE Protocol – Step 2 — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateEpilepsy & Seizure DisordersSE Protocol – Step 2SCE Neurology

A 65-year-old man with known epilepsy and intellectual disability has a seizure. His carer uses buccal midazolam. Despite administering the correct dose, the seizure continues after 10 minutes. Paramedics arrive. What is the next step per the SE protocol?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — IV lorazepam 4 mg (or repeat buccal midazolam/rectal diazepam if IV access unavailable) — this is step 2 of the SE protocol at 10 minutes

The SE treatment protocol (NICE NG217): Step 1 (0–5 minutes): buccal midazolam or rectal diazepam in the community. Step 2 (10 minutes): if seizure continues, IV lorazepam 4 mg (repeat once after 10 minutes if needed); if no IV access, repeat buccal midazolam or rectal diazepam (once only). Step 3 (25 minutes): if seizure continues despite 2 doses of benzodiazepine, IV phenytoin (or IV levetiracetam/valproate as alternatives) with anaesthetic standby. Step 4 (45 minutes): general anaesthesia (propofol, midazolam, or thiopental). A: Maximum 2 doses of benzodiazepine. C: Oral not appropriate during seizure. D: Delaying risks damage. E: No anticonvulsant effect.

Reference: NICE NG217 (2025); ABN SE Guidelines