A fictional 46-year-old continues to have a generalised convulsive seizure five minutes after arrival. No individual emergency plan is immediately available.
Listen for the assumption.
I wanted to obtain a CT scan before giving treatment because this is a first seizure.
At five minutes this is convulsive status epilepticus. Resuscitation, glucose assessment and first-line treatment cannot wait for imaging.
I will time every treatment and investigate the cause while the emergency algorithm proceeds.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Seizure duration exceeds five minutes
- Capillary glucose is available at the bedside
- No emergency plan is immediately available
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Use the current status algorithm, avoid repeated untracked dosing and assign someone to record seizure and treatment times.
Prepare the refractory pathway early while simultaneously addressing infection, metabolic disturbance, toxins, adherence and structural causes.
The handover will include exact timings, glucose, airway status, drugs given and response.
What must remain explicit.
- Use the current local status epilepticus algorithm.
- Record all doses and times to prevent duplication.
- Escalate airway and critical-care planning early.
Where reasoning fails.
- Waiting for imaging
- Missing hypoglycaemia
- Uncoordinated repeated sedative dosing
Convulsive status from [time], airway/oxygenation [status], glucose [result], treatments [dose/time/response], likely cause [assessment] and refractory plan [status].
Who owns the timeline during a status epilepticus call in your unit?