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Convulsive status epilepticus — SCE Acute Medicine MCQ

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ModerateNeurology and ophthalmologyConvulsive status epilepticusSCE Acute Medicine

A 46-year-old man with known epilepsy has a generalised tonic-clonic seizure in the AMU lasting 7 minutes. He has had two similar seizures en route and has not regained consciousness between episodes. Capillary glucose is 5.8 mmol/L and oxygen saturation is 93% with airway manoeuvres. What is the most appropriate next step in management?

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Correct answer: D — Give intravenous lorazepam and prepare second-line antiseizure treatment

This is established convulsive status epilepticus because seizures are prolonged and recurrent without recovery, so benzodiazepine treatment is urgent. Waiting increases neuronal injury and cardiorespiratory risk. Second-line therapy should be prepared early because repeated benzodiazepines alone may cause respiratory depression without terminating seizures.

Reference: NICE NG217 epilepsies; Resuscitation Council UK ALS seizure guidance