Case report

A 20 year old man was brought to the A&E department by emergency ambulance. He had a past medical history of post-traumatic epilepsy after sustaining a depressed skull fracture eight years earlier. He had been found by his father at home 80 minutes earlier having continuous tonic-clonic seizures. The ambulance crew had administered high flow oxygen via a nasopharyngeal airway and administered 10 mg intravenous (IV) diazepam (Diazemuls) en route to hospital.

On arrival, rapid examination confirmed continuing tonic-clonic status epilepticus. Vital signs were as follows: pulse rate 140 beats per minute, sinus rhythm; respiratory rate 25 per minute; non-invasive blood pressure 130/80 mm Hg; oxygen saturation 98% (on high flow oxygen). He had trismus complicated by copious secretions, but basic airway manoevres, a nasopharyngeal airway and suction proved sufficient to maintain a patent airway. There was no evidence of recent, new head injury and his blood glucose was 7.0 mmol/l on bedside testing. He was given IV lorazepam 4 mg with no effect; this was repeated after five minutes, again with no effect.

Background information was available from the patient's father. He had been admitted two …