B is the correct answer. Why?

Explanation

Seizures typically have five properties: abrupt onset (sometimes with visual, olfactory, or auditory auras), brief duration (usually 1–2 min), alteration of consciousness, purposeless and nonsuppressible (tonic-clonic or focal) movements, and a postictal state (lethargy, confusion, and impaired recall of events). Most patients will recover from a seizure without further intervention. However, some develop status epilepticus, continuous seizure activity for > 5 minutes or repeat seizure without return to neurologic baseline. In this case, patients require a more extensive ED evaluation and workup and pharmacologic treatment to cease the seizure activity.

Patients presenting with seizures should be placed on cardiac monitoring and have an ECG performed, as cardiogenic syncope can mimic seizures. An ECG can also identify a prolonged QT interval or other abnormalities that may lead to an increased risk of dysrhythmias. Serum laboratory studies should include serum electrolytes, liver function tests, and a pregnancy test when applicable. A creatine kinase and lactic acid level may be indicated in patients with prolonged seizure activity. Serum drug levels should be obtained (if available) for patients who are taking anticonvulsant medications and who have a history of seizures. A CT scan of the brain is quick, is usually readily available, and is recommended in most patients with new-onset seizures. CT imaging is not routinely performed in patients with a history of seizure disorder but may be indicated if patients do not return to their baseline mentation or if the seizure has caused significant head trauma.

Treatment of patients with seizures should include airway monitoring and protection from injuries related to seizures. The patient should be placed in the lateral decubitus position to reduce aspiration risk. Benzodiazepines are recommended as first-line medications. Second-line therapies include valproic acid, phenytoin, fosphenytoin, and levetiracetam.

Ketamine (A), pentobarbital (C), and propofol (D) are all third-line agents used to treat refractory seizures. Typically, patients require endotracheal intubation and electroencephalogram monitoring when receiving these medications.