25th June 2023

A 32-year-old man with known epilepsy and known generalised tonic-clonic seizures is blue lighted into resus with an ongoing 15-minute generalised tonic seizure

A 32-year-old man with known epilepsy and known generalised tonic-clonic seizures is blue lighted into resus with an ongoing 15-minute generalised tonic seizure. Rectal diazepam 20mg kept at home was given by his partner after the seizure didn’t stop at the usual 2 minutes, but to no effect.

Paramedics inserted a nasopharyngeal airway and put him on 15L of oxygen but struggled to get a cannula in due to the ongoing seizure.

An oropharyngeal airway has been inserted and is tolerated by the patient in resus. IV access has now been established in resus. His blood glucose is in normal range. ITU has been made aware of the patient.

What is the best medication to start him on to try to control his seizure?