Venous blood gas (to measure lactate and acidosis) and venous bloods including FBC, LFTs, U&Es, Ca2+, PO43-, Mg2+ (look for electrolyte abnormalities), antiepileptic drug levels (if taking), clotting
ECG (look for prolonged QT interval)
Urine toxicology screen (if relevant)
Further investigations
CT/MRI brain (look for any focal lesions or bleed)
Please note OSCEstop content is for educational purposes only and not intended to inform clinical practice. OSCEstop and authors take no responsibility for errors or the use of any information displayed.Drugs and doses are intended for non-pregnant adults, who are not breastfeeding, with normal renal and hepatic function.
If seizure ongoing, within:
10 minutes: 4mg lorazepam IV OR 10mg diazepam PR
20 minutes: repeat above
30 minutes: levetiracetam (Keppra) 60mg/kg IV (max. 4.5g; over 15 minutes; unlicenced) or phenytoin 20mg/kg IV (max. 2g; at 50mg/minute with cardiac monitoring)
60 minutes: general anaesthesia in intensive care unit
Plus:
If hypoglycaemia: 50ml 50% glucose IV
If any suggestion of alcohol dependence: Pabrinex I+II 2 pairs IV
Treatment for any obvious causes
After patient has recovered consciousness
Post-ictal period may last a few hours
Find cause
Full history
Multi-system examination (including full neurological exam)
Complete any outstanding investigations above
Treat cause
Refer to medical team/neurology or seizure clinic
Give driving advice and instruct patient to inform DVLA
