A 60-year-old, 80-kg man is evaluated in the emergency department withstatus epilepticus. He has a history of intracranial tumor. Emergency medical personnel gave him midazolam, 8 mg, IV bolus, in the ambulance, and lorazepam, 4 mg, IV bolus, in the emergency department. He remains unresponsive with left gaze deviation, and is subsequently intubated. Which of the following is/are the best next step(s) in management?
A. Propofol infusion
B. Additional lorazepam
C. Diagnostic EEG and neurology consult
D. Loading dose of fosphenytoin
E. Levetiracetam
答案解析:
该患者患有苯二氮卓类药物难治性癫痫持续状态。下一步最好的是给他装上磷苯妥英。丙泊酚输注并不错误,但必须在患者至少两种初始标准治疗失败后进行。虽然临床上使用左乙拉西坦,但尚无足够的数据将其作为癫痫持续状态的一线药物。患者仍在癫痫发作,EEG是一种诊断模式,而不是一种治疗选择。
正确答案:D
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