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Convulsive status epilepticus — SCE Acute Medicine MCQ

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EasyAcute Neurological PresentationsConvulsive status epilepticusSCE Acute Medicine

A 40-year-old man has a generalised tonic-clonic seizure in the AMU lasting seven minutes. Oxygen has been applied, glucose is 6.1 mmol/L and there is no IV access yet. He has known epilepsy and missed levetiracetam for two days. What is the most important immediate action?

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Correct answer: B — Give buccal midazolam or intramuscular benzodiazepine

A convulsive seizure lasting beyond five minutes is status epilepticus and needs immediate benzodiazepine treatment by an available route. Waiting increases risk of pharmacoresistance and hypoxic injury. Oral medication is unsafe during an active convulsion. The pearl is that early airway positioning, oxygen, glucose check and benzodiazepine are parallel actions.

Reference: NICE NG217; Resuscitation Council UK