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Status epilepticus in an adult — DipIMC MCQ

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HardMedical EmergenciesStatus epilepticus in an adultDipIMC

A 39-year-old has a generalised convulsive seizure lasting seven minutes. Oxygenation is supported, glucose is normal, no individual emergency plan is available and IV access cannot be obtained. Which treatment is indicated now?

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

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Correct answer: E — Give buccal midazolam using the adult emergency dose

The best answer is “Give buccal midazolam using the adult emergency dose”. A convulsive seizure lasting five minutes or more is status epilepticus. NICE recommends immediate buccal midazolam, or rectal diazepam, in the community when an individual plan is unavailable and IV access with resuscitation facilities is not immediately available. Oral treatment is unsafe during convulsions, while phenytoin is an intravenous second-line medicine after adequate benzodiazepine treatment.

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