Status epilepticus scenario
Adult status epilepticus
candidate brief
actor brief
examiner brief
Unknown mixed overdose
Started seizing with ambulance crew - has not regained consciousness
Ambulance interventions: IV cannula, 1x lorazepam, 400mcg naloxone - no effect
At minute 4, starts seizing again
- Checks team competencies
- Takes handover and appropriate history
- Starts clock
- Airway assessment - tolerating NP, considers further adjuncts
- Breathing - Applies high flow oxygen
- Gives max 1 more dose of benzodiazepine - IV lorazepam vs buccal midazolam?
- Prepares loading levetiracetam dose - 60mg/kg, max 4500mg
- Plans for RSI
- Escalates to specialty appropriately
- Suggests further investigations
- ECG (tox resus)
- CT head (investigating cause of seizure)
- Global mark
sources/links
Keppra dosing is not in BNF (!), but with reference to WAHT, Nottingham University Hospitals and Royal Cornwall Hospitals trust guidelines
https://emcrit.org/ibcc/sz/