A 24-year-old man is brought to the emergency department in continuous tonic-clonic convulsions; the onset was witnessed 20 minutes ago. He has received two adequate doses of intravenous lorazepam without termination of seizure activity. What is the next step in management?

• A Repeat a third dose of intravenous lorazepam
• B Intravenous fosphenytoin infusion ✓
• C Immediate intubation and propofol coma with EEG monitoring
• D Intramuscular midazolam and reassess after 10 minutes

Explanation

Seizures persisting beyond the established benzodiazepine doses define established status epilepticus, and a second-line intravenous antiseizure agent such as fosphenytoin, valproate, or levetiracetam is indicated. Repeating lorazepam adds little efficacy and increases respiratory depression. Intubation with anesthetic infusions is reserved for refractory status that persists after adequate second-line therapy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.