A 24-year-old man is brought to the emergency department convulsing continuously. The nursing staff confirm he has been seizing for at least 7 minutes and has not received any medication. After securing airway, oxygen, and IV access, what is the correct next step?
- A IV lorazepam 0.1 mg/kg ✓
- B IV phenytoin loading dose
- C IV levetiracetam loading dose
- D Immediate intubation and propofol infusion
Correct answer: A. IV lorazepam 0.1 mg/kg
Explanation
Status epilepticus is defined as continuous seizure activity for 5 minutes or more. Benzodiazepines are the established first-line therapy at this stage, and IV lorazepam is the preferred agent because of its longer duration of action than diazepam. Phenytoin, levetiracetam, or valproate are second-line drugs given only if seizures continue after adequate benzodiazepine. Intubation with anaesthetic infusion is reserved for refractory cases.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.