Approach to a first unprovoked seizure (pediatrics) Quiz: Ace Your Exams

A 15-month-old toddler is brought to the emergency department by ambulance for evaluation of altered mental status and convulsions. She was playing in the sandbox at the park prior to arrival when she suddenly stared off into space and then experienced stiffening of her limbs and rhythmic jerking. Pregnancy and delivery were uncomplicated, and there is no significant past medical history. She does not take any medication. She has not been ill or unsupervised recently. In the ambulance, the stiffening and rhythmic jerking of the limbs stopped. However, the patient remains unconscious. Emergency medical services are unable to obtain intravenous access. Temperature is 37°C (98.6°F), pulse is 100/min, respirations are 30/min, and blood pressure is 88/50 mmHg. On exam, the patient is unresponsive with flexion of the bilateral upper extremities and extension of the bilateral lower extremities. The neck is supple, and no rashes are seen. In the emergency department, the patient starts experiencing witnessed convulsions. Which of the following is the most appropriate next step in management?