258.A 40-year-old man who is an employee of the hospital is brought to the
ED actively seizing. A coworker states that the patient has a known seizure
disorder and currently takes phenytoin for the disorder. He also tells you that
the patient has been under stress recently and may not have taken his last few
doses of medication. You call for the nurse to place a face mask with 100%
oxygen and gain IV access. You then ask for a medication to be drawn up.
Which is the most appropriate initial medication you should administer in
this actively seizing patient?
a. Phenytoin
b. Diazepam
c. Phenobarbital
d. Valproic acid
e. Lithium
259.A 32-year-old gravida 1, para 1 who gave birth by normal vaginal
delivery at 38-weeks gestation 2 days ago presents to the ED complaining of
bilateral hand swelling and severe headache that started 2 hours ago. Her BP
is 187/110 mm Hg, HR is 85 beats per minute, temperature is 97.5°F, and
RR is 15 breaths per minute. Urinalysis reveals 3+ protein. As you are exam-
ining the patient, she proceeds to have a generalized tonic-clonic seizure.
Which of the following is the most appropriate next step in management?
a. Administer magnesium sulfate IV.
b. Administer labetalol to reduce her BP and morphine sulfate to address her
headache.
c. Administer sumatriptan and place the patient into a dark quiet room.
d. Administer a loading dose of phenytoin, order a head CT scan, and call for a
neurology consult.
e. Administer diazepam and normal saline IV.
272 Emergency Medicine