Sun28November0440PM 12

You are called urgently to review a 29-year-old man presenting with seizures. He is known to have epilepsy and is maintained on sodium valproate. He also has a previous history of alcohol abuse. He has been suffering with a seizure for the past 10 minutes.

The airway is being managed, and his blood sugar is 6 mmol. Intravenous access has been secured and diazepam has been administered initially by the ambulance crew and again in A&E.

Which of the following medications would you choose next?

(Please select 1 option)

Intravenous propofol

Intravenous Pabrinex

Intravenous phenytoin Correct

Intravenous lorazepam

Intravenous midazolam

Explanation

By definition status epilepticus is a seizure which lasts for longer than 30 minutes. However, the longer a seizure lasts the more refractory to treatment it becomes. The average seizure will self terminate after two minutes or so.

Emergency management of a seizure is as follows:

Airway, breathing, circulation

Check for and treat hypoglycaemia and electrolyte disturbance.

In status epilepticus:

Early management is with intravenous lorazepam or diazepam

Established management with intravenous phenytoin, and

Refractory management (on intensive care) with propofol, midazolam or thiopentone.

Administration of intravenous thiamine may be helpful in those with a history of acute alcohol withdrawal.

In dealing with patients please refer to local guidelines as there is little evidence available due to the emergency nature of patient presentation.

Answer Statistics

1

2%

2

5%

3

38%

4

55%

5

2%

Times answered: 298