Status seizure adult — DipIMC MCQ

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ModerateMedical EmergenciesStatus seizure adultDipIMC

A 42-year-old has continuous tonic-clonic seizure activity for 8 minutes. There is no intravenous access and airway equipment is ready. What is the most appropriate drug/dose?

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

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Correct answer: E — Buccal or intranasal midazolam 10 mg

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · B = shown as D · C = shown as E

C is correct: A prolonged adult convulsive seizure without IV access is treated with a non-IV benzodiazepine such as midazolam 10 mg. A is less suitable because rapid IV benzodiazepine bolus carries avoidable respiratory risk; B is less suitable because antihistamine is adjunctive and must not delay adrenaline in anaphylaxis; D is less suitable because the dose is below standard severe adult asthma nebuliser dosing; E is less suitable because it is a common auto-injector dose rather than the adult healthcare dose. The most tempting alternative is therefore suboptimal because it either delays the time-critical pre-hospital intervention or sends the patient to the wrong level of care. The key DipIMC principle is focused cABCDE decision-making with early pre-alert, triage or retrieval escalation when the scene physiology demands it.

Reference: JRCALC Guidelines; Resuscitation Council UK; NICE guidance where applicable