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Status epilepticus — DIPIMC MCQ

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HardMedical EmergenciesStatus epilepticusDIPIMCDipIMC

A 25-year-old has been having a generalised tonic-clonic seizure for seven minutes. He has intravenous access and the crew gave one dose of intravenous lorazepam five minutes ago without effect. What is the most appropriate next step?

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Correct answer: A — Give a second dose of intravenous lorazepam and prepare second-line therapy if seizures persist

In established status epilepticus, a second dose of a benzodiazepine such as intravenous lorazepam is given after the first fails, while a second-line agent (for example levetiracetam, phenytoin or sodium valproate) is prepared in case seizures continue. Repeated unlimited benzodiazepine boluses risk respiratory depression. Phenytoin is a second-line agent used after benzodiazepines, and oral therapy is inappropriate during an active seizure. Pearl: guidance advises a maximum of two doses of benzodiazepine before escalating to second-line treatment.

Reference: JRCALC Clinical Guidelines