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Status epilepticus in accident and emergency: a difficult case
  1. C A Graham,
  2. M W G Gordon
  1. Accident and Emergency Department, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, Scotland
  1. Correspondence to: Mr Graham (ColinGraham{at}bigfoot.com)

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Status epilepticus is an acute medical emergency requiring effective immediate treatment to avoid excess morbidity and mortality.1 It is generally regarded as seizure activity lasting continuously for more than 20 minutes or multiple seizures with incomplete recovery between seizures lasting a total of 20 minutes or more, as this is the period necessary to cause injury to neurones.2 It is a relatively common presentation in accident and emergency (A&E) practice and it can present considerable difficulties in management. We present a case of status epilepticus that raised several therapeutic issues.

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 …

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