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Convulsive status epilepticus — ACEM Fellowship MCQ

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HardNeurological emergenciesConvulsive status epilepticusACEM Fellowship

A 25-year-old man has ongoing generalised convulsive activity nine minutes after onset. Glucose is 5.8 mmol/L, there is no trauma, and intravenous access is available. He has received no anticonvulsant. According to the NSW adult emergency protocol, what should be given first?

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

Reveal the answer and explanation

Correct answer: D — Midazolam 5 mg IV, repeat after five minutes

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

E is correct. Ongoing generalised convulsive activity for nine minutes requires first-line benzodiazepine treatment. Under the NSW adult protocol, give midazolam 5 mg IV and repeat once after five minutes if required. The other medicines can be used in selected seizure pathways but are not the protocol’s initial first-line treatment.

Reference: NSW Agency for Clinical Innovation: Adult ECAT—Seizures: https://aci.health.nsw.gov.au/ecat/adult/seizures