QuestionPrescription
QuestionComment
BNF states that IV lorazepam can also be used in status
6369
QuestionComment
but he doesnt have any IV access
6810
User
subscriber
Retrograde Contusion
User
subscriber
Giggy G
QuestionComment
here it said the concentration of midazolam was 5 mg / ml. I said the answer was therefore 1 ml of solution (because there are 5 mg of midazolam in that). But it was wrong? Would you get this wrong in the real exam? Because in real life you would give 1 ml of solution???
60808
User
subscriber
Axillary JAK
QuestionComment
It's only wrong if the exam is asking you for the dose in mg and not the volume to be administered, which was the case for this Qu (the answer units were in mg). As a general rule of thumb, the prescriber states the dose in mg, as the person giving the medication would then need to decide how it's administered
61165
User
subscriber
DJnR
QuestionComment
prescribed 5 mg midaz and oromucosal and it wasn't accepted bc they only take that combination with "buccal" 
61341
User
subscriber
Vaccine Complement
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2700
Febrile seizure
Topic
91
Paediatrics
# Drug choice feedback

This child is most probably suffering from febrile seizures secondary to the ongoing viral infection, and given his past and family history of febrile seizures. Importantly, other major causes of paediatric seizures such as meningococcal disease or hypoglycaemia are excluded based on the examination findings and his blood glucose being normal respectively. As he is still seizing after five minutes, emergency treatment with either diazepam or midazolam should be initiated.

# Dose/Route/Frequency/Duration feedback

Diazepam should be given PR while midazolam should be given buccally. The optimal doses are as above.
6766
PrescriptionAnswer
PrescribeAnswerData
5 mg
PrescribeAnswerData
midazolam 5 mg/mL oromucosal solution
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
buccal
PrescriptionAnswer
PrescribeAnswerData
2.5 mL
PrescribeAnswerData
diazepam 10 mg/2.5 mL rectal solution
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
rectal (PR)
PrescriptionAnswer
PrescribeAnswerData
10 mg
PrescribeAnswerData
diazepam 10 mg/2.5 mL rectal solution
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
rectal (PR)
PrescriptionAnswer
PrescribeAnswerData
1 mL
PrescribeAnswerData
midazolam 5 mg/mL oromucosal solution
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
buccal
PrescriptionAnswer
PrescribeAnswerData
5 mg
PrescribeAnswerData
diazepam 10 mg/2.5 mL rectal solution
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
rectal (PR)
PrescriptionAnswer
PrescribeAnswerData
1.25 mL
PrescribeAnswerData
diazepam 10 mg/2.5 mL rectal solution
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
rectal (PR)
Case Presentation: A 3-year-old boy attends the Emergency Department with his mother with a high fever and cough. No changes in urinary habit and no travel history noted. While waiting to be seen, he suddenly begins seizing.




## PH


Febrile seizures


## DH


None (NKDA)


## FHx


Father had febrile seizures as a child


## On examination


The child is having generalised, tonic-clonic seizure. He was not noted to be irritable, drowsy beforehand. No neck stiffness, no rash seen, fontanelle not bulging.
No cannula has been inserted.


Temperature 38.9°C, HR 120, RR 25, BP 96/68, O<sub>2</sub> 98% RA, GCS 15 (before seizure began), Weight 15kg


## Investigations


BM: 5.5 mmol/L (normal range 3.5-5.5 mmol/L).


All other investigation results are pending.


# Prescribing Request


Write a prescription for one drug that is most appropriate for treating his condition should it still persist after five minutes.