A 28-year-old female with a history of epilepsy presents to the ED with ongoing seizure activity for the past 45 minutes. She has received two doses of lorazepam without resolution. Her vital signs are: BP 160/90, HR 120, RR 22, SpO2 92% on room air. Which of the following is the most appropriate next step in management?
The correct answer is to administer fosphenytoin or phenytoin. This patient is in status epilepticus, defined as continuous seizure activity lasting more than 30 minutes or recurrent seizures without return to baseline. After initial treatment with benzodiazepines (in this case, lorazepam), the next step is to administer a long-acting antiepileptic drug, typically fosphenytoin or phenytoin. Propofol is used for refractory status epilepticus and would be considered if the seizures persist after antiepileptic drugs. While intubation may eventually be necessary, it's not the immediate next step. Phenobarbital is typically a third-line agent. CT scan, while important for identifying underlying causes, is not the immediate priority when actively seizing. The goal is to stop the seizure activity as quickly as possible to prevent neurological damage.
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Neurological Emergencies
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