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Status epilepticus after benzodiazepine treatment — RCPSC EM MCQ

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HardNeurological emergenciesStatus epilepticus after benzodiazepine treatmentRCPSC EM

A child remains in convulsive status after two adequate benzodiazepine doses, including one given by EMS. Glucose is normal and ventilation is supported. What is the next pharmacologic step?

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

Reveal the answer and explanation

Correct answer: A — Load levetiracetam, fosphenytoin or valproate and prepare airway escalation

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

C is correct after two benzodiazepine doses. D increases respiratory depression without improving seizure control. E is unsuitable for emergency loading. A uses an obsolete treatment threshold. B prematurely skips effective second-line choices, though anesthetic infusion follows if seizures become refractory.

Reference: Canadian Paediatric Society, Emergency management of paediatric convulsive status epilepticus: https://cps.ca/en/documents/position/emergency-management-of-the-paediatric-patient-with-convulsive-status-epilepticus