Status Epilepticus (2022)

Location: You are an FY1 on the medical assessment unit

Patient: You have come to take blood from a patient, as you are walking into the bay the emergency buzzer has been activated and a nurse is shouting for help

Task:
– Perform a full ABCDE assessment, a nurse will be available to help you with investigations or management that you require.
– After 6 minuets you will be asked a series of questions by the examiner.
– Answer any questions that the patient may have

Note to actor: Try to restrain yourself from volunteering to much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.

You will be laying on your right hand side. Your arms and legs are shaking, your teeth are gritted shut and will not open

Nurse history:
– Patient is a known epileptic
– Patient has just been transferred to the wards this morning, after being admitted late last night.
– Nurse saw patient begin seizing and shouted for help at same time
– No drug allergies

Category	Question	Done	Excellent
History	History from nurse Patient is a known epileptic Nurse saw patient begin seizing and shouted for help at same time No drug allergies
Airway assessment	Airway assessment Teeth are grit shut Unable to insert gadel to maintain airway. Candidate offers a nasopharyngeal airway
Breathing assessment	Breathing assessment Oxygen saturation = 88% on RA Respiratory rate = unable to determine Position of trachea = central Chest expansion = equal Chest sounds = clear
Breathing treatment	Breathing treatment Oxygen 15L through non-rebreathing mask
Circulation assessment	Circulation assessment Blood pressure – 90/87 Heart rate – 110 Peripheral and central cap refill – < 2 seconds Heart sounds = I + II + 0
Circulation investigations	Circulation investigations 2 large bore IV cannulae Bloods = FBC, U&E, CRP, VBG
Additional bloods	Additional blood tests requested Any one of: Na, B-hcg, Alcohol, Drug levels
Circulation treatment	Circulation treatment 500ml of 0.9% normal saline STAT
Disability assessment	Disability assessment Blood glucose = 6.7 Temperature = 37 U on AVPU
Diagnosis	Diagnosis Candidate verbalizes diagnosis of status epilepticus
Status treatment	Status treatment Lorazapam 4mg IV bolus OR Diazepam 10mg PR (if no IV access)
Question	If after 10mins the patient is still having a seizure what should you do? If ongoing seizure give 2nd dose of Lorazapam 4mg IV
Question	If after 2 doses of lorazepam patient is still in status, what other medication can be given? Phenytoin
Question	What is the most likely cause of status for this patient? Not prescribed regular medications

Submit your answers to get your score.

Status Epilepticus

Submit your answers to get your score.

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