Working Up Causes of Seizure

In Episode 52 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question: A 26-year-old woman is brought to the emergency department by ambulance. Her roommate called the paramedics after witnessing a generalized tonic-clonic seizure. Review of her medical records reveals that she has history of depression and hypothyroidism, but there is no known history of epilepsy. Upon arrival, she is somnolent but arouses to painful stimuli. Temperature is 38.2 C, heart rate is 128/min, respiratory rate is 20/min, blood pressure is 83/51, and oxygen saturation is 95%. On examination she is flushed and diaphoretic. Pupils are 6 mm and poorly reactive to light. Mucous membranes are dry. Her airway is patent and her pulmonary examination is unremarkable. Her abdomen is soft, mildly distended, and bowel sounds are absent. She is placed on 2L of 100% O2 by nasal cannula, and a normal saline IV bolus is initiated. Serum glucose is 85, and other laboratory studies are pending. Electrocardiogram reveals sinus tachycardia and QRS duration of 130 msec. What is the next best step in management?

• Physostigmine
• Procainamide
• Metoprolol
• Naloxone
• Phenytoin
• Sodium bicarbonate
• Flecainide
• Activated charcoal