Initial management steps for status epilepticus in an adult?

• A. Administer benzodiazepine (lorazepam), then IV antiseizure medication such as phenytoin or valproate; secure airway and treat metabolic triggers
• B. Administer oral antiseizure medication only
• C. Immediate brain imaging without treatment
• D. Place patient in prone position and wait

Answer: (A)

In status epilepticus, the priority is rapid seizure control while keeping the patient airway-safe and evaluating reversible triggers. The best initial approach is to give a benzodiazepine promptly to abort the ongoing seizure, with lorazepam given IV as a standard first-line option because it quickly enhances GABAergic inhibition and has a duration of action that helps stop the seizure. If the seizures continue after the benzodiazepine, you should escalate to an IV antiseizure medication such as phenytoin or valproate (or levetiracetam) to prevent recurrence. At the same time, secure the airway as needed and address metabolic precipitants—check glucose and correct hypoglycemia, correct electrolyte disturbances, and treat other reversible factors. Immediate brain imaging or delaying treatment until imaging is obtained would not address the urgent need to stop the seizure, and waiting or positioning alone is not sufficient.