Status Epilepticus


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

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 ACDE 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



Score