An adult patient has been seizing continuously for 6 minutes. The provider asks the nurse to anticipate the first-line pharmacologic intervention. Which medication should the nurse have ready?
1IV lorazepam 4 mg over 2 minutes; may repeat once after 5 to 10 minutes if seizing continues.✓ Correct answer
2IV phenytoin 20 mg/kg loading dose infused at 50 mg/min; may repeat 10 mg/kg after 10 minutes.
3Subcutaneous epinephrine 0.3 mg into lateral thigh; may repeat after 5 to 15 minutes if needed.
4IV mannitol 1 g/kg over 20 minutes to lower intracranial pressure; may repeat 0.5 g/kg after 6 hours.
Explanation
Status epilepticus = continuous seizure ≥ 5 minutes (or recurrent without return to baseline). The first-line agent is an IV benzodiazepine — lorazepam 4 mg IV (or midazolam 10 mg IM if no IV access). Phenytoin/fosphenytoin is the SECOND-line agent if seizures persist. Mannitol and epinephrine are not used for status. Airway, oxygen, side positioning, and IV access run in parallel.
Memorize the staircase: benzo → fosphenytoin/levetiracetam/valproate → propofol or midazolam infusion (refractory). Lorazepam 4 mg IV is the most-tested first-line answer. Time matters: each minute of seizing increases morbidity and refractoriness.
Adult patient with continuous tonic-clonic seizure activity for 6 minutes — meets criteria for status epilepticus. Airway is being managed with side positioning and suction. IV access is established.
Status epilepticus — Continuous seizure ≥ 5 minutes or recurrent seizures without return to baseline; medical emergency.
IV lorazepam — First-line benzodiazepine; 4 mg IV over 2 minutes, may repeat once.
Fosphenytoin (second-line) — Loading 20 mg PE/kg IV after benzodiazepines fail; less hypotension than IV phenytoin.