02-16-2010, 11:07 AM
A 41-year-old man is seen in clinic for a single episode of loss of consciousness. The man does not recall ever having lost consciousness before. This episode began soon after awakening this morning. His recollection of the event is clouded but he does remember an initial odd sensation that œsomething was not right. Next, he found himself laying on the kitchen floor, confused and obviously having lost bladder control. After a complete physical examination and metabolic work-up, followed by electroencephalogram (EEG) and head computed tomography (CT) studies, there is no definitive evidence that the patient suffers from epilepsy. Nevertheless the physician informs the man that the episode probably represents a true epileptic attack and that there is a good chance that he will experience additional seizures. Further, the physician explains that there are drugs that can reduce the risk of suffering additional seizures, but that all have risks associated with their use. After reviewing the patient's medical history, the physician recommends that drug therapy be instituted to attempt to prevent future seizures.
Item 2 of 3
After concluding his discussion with the patient, the physician leaves the examination room but is called back by his nurse a few minutes later. The man is laying on the floor with generalized flexor spasms. The spasms abate for a 30-second period then recur. This pattern continues, with the patient not breathing between episodes of spasms. The physician manages to place an oral airway and with the aid of the nurse and other office personnel, to move the man to a hospital gurney where he is placed in the left lateral decubitus position. Pulse oximetry shows 92% O2 saturation. Vital signs are temperature 37.9°C (100.2°F), blood pressure (BP) 150/95 mm Hg, heart rate 110 beats per minute and respiration rate 12 breaths per minute during the flexor spasm phase and 0 breaths per minute between spasm phases. A large bore peripheral intravenous line (IV) is placed in the right arm. Blood samples are obtained for laboratory analysis. Seizure activity has persisted for longer than 5 minutes. What is the next management step?
A. Administer 50% dextrose as a 50 mL IV bolus.
B. Administer IV Phenobarbital 20 mg/kg over 10 to 15 minutes.
C. Administer naloxone 0.1-2 mg IV push.
D. Administer Phenytoin 10-20 mg/kg IV push.
E. Intubate the patient, administer normal saline at 75-125 mL per hour.
Item 2 of 3
After concluding his discussion with the patient, the physician leaves the examination room but is called back by his nurse a few minutes later. The man is laying on the floor with generalized flexor spasms. The spasms abate for a 30-second period then recur. This pattern continues, with the patient not breathing between episodes of spasms. The physician manages to place an oral airway and with the aid of the nurse and other office personnel, to move the man to a hospital gurney where he is placed in the left lateral decubitus position. Pulse oximetry shows 92% O2 saturation. Vital signs are temperature 37.9°C (100.2°F), blood pressure (BP) 150/95 mm Hg, heart rate 110 beats per minute and respiration rate 12 breaths per minute during the flexor spasm phase and 0 breaths per minute between spasm phases. A large bore peripheral intravenous line (IV) is placed in the right arm. Blood samples are obtained for laboratory analysis. Seizure activity has persisted for longer than 5 minutes. What is the next management step?
A. Administer 50% dextrose as a 50 mL IV bolus.
B. Administer IV Phenobarbital 20 mg/kg over 10 to 15 minutes.
C. Administer naloxone 0.1-2 mg IV push.
D. Administer Phenytoin 10-20 mg/kg IV push.
E. Intubate the patient, administer normal saline at 75-125 mL per hour.