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Tricyclic antidepressant overdose — DipIMC MCQ

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HardMedical EmergenciesTricyclic antidepressant overdoseDipIMC

A 20-month-old has been convulsing for six minutes with fever. Airway positioning, oxygen and glucose assessment are underway; a parent has no individual emergency plan. Which medication principle is most appropriate?

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Correct answer: C — Give buccal midazolam now using the protocolled age-based dose

The best answer is “Give buccal midazolam now using the protocolled age-based dose”. A seizure lasting five minutes or more requires emergency benzodiazepine treatment after ABC support and glucose assessment. Buccal midazolam is a recommended community route when an individual plan is unavailable; the exact paediatric dose must follow age and local protocol. Antipyretics do not terminate prolonged seizures, and adult IV loading regimens are inappropriate without paediatric resuscitation capability.

Reference: NICE NG217, Epilepsies: status epilepticus: https://www.nice.org.uk/guidance/ng217/chapter/7-Treating-status-epilepticus-repeated-or-cluster-seizures-and-prolonged-seizures