Quick answer
How should I present an ongoing status epilepticus case?
This is one of the few presentations that should be shorter than usual: state the diagnosis and duration first, then vitals and glucose, then exactly which medication step you are on. Do not wait to give a full history before starting treatment. Finish with the next step in the cascade if the current one fails.
Before you speak
Define the moment and the information you actually have
An emergency-department presentation while the seizure is still ongoing, immediately after point-of-care glucose returns.
The emergency team needing an immediate, action-oriented update rather than a full history.
A brief history from bystanders, vital signs, exam findings during the seizure, and point-of-care glucose. Anti-seizure drug levels and a full medication list are not supplied.
About 45 seconds
Fictional training case: The presentation is locked to the simulated patient JSON. It names important unknowns instead of inventing an examination, vital signs, allergies, or tests.
Complete spoken example
First, read it once without stopping
The paragraph breaks show the clinical shape. In a real presentation, pause briefly between ideas rather than announcing the headings.
Mr. Walker is a 31-year-old man with known epilepsy who has been continuously seizing for eight minutes; this is status epilepticus and he needs immediate treatment.
He was brought by ambulance actively convulsing, with no reported recovery of consciousness between movements; whether he sustained head trauma during the fall has not been confirmed.
He has known epilepsy, though his specific anti-seizure medication is not documented, and he has no other reported medical history.
His vitals show a heart rate of 138, blood pressure 158 over 94, respiratory rate 22, temperature 38, and oxygen saturation 88% on room air. Point-of-care glucose is 104, ruling out hypoglycemia as the cause.
This is generalized convulsive status epilepticus in a patient with known epilepsy, and it needs immediate stepwise treatment rather than further diagnostic discussion right now.
Airway, oxygen, and glucose have already been addressed. I am giving IV lorazepam now as first-line therapy, and if the seizure continues past five minutes after this dose, I will move to a second-line agent such as levetiracetam, fosphenytoin, or valproic acid, with continuous EEG and ICU-level care if it persists further.
Build the presentation
Give every sentence one job
A presentation is a compressed clinical argument, not a chart read aloud. These six moves keep the facts connected to your reasoning.
Opening one-liner
State the emergency and the clock immediately
“Mr. Walker is a 31-year-old man with known epilepsy who has been continuously seizing for eight minutes; this is status epilepticus and he needs immediate treatment.”
Why it belongs: In this presentation the diagnosis and the exact duration matter more than any other detail, because the entire management cascade is timed from seizure onset.
He's still seizing and has epilepsy.
He has been continuously seizing for eight minutes; this is status epilepticus and needs immediate treatment.
Why: Naming the diagnosis and exact duration in the first sentence prompts immediate action rather than a routine history.
History of present illness
Give only what bystanders could confirm
“He was brought by ambulance actively convulsing, with no reported recovery of consciousness between movements; whether he sustained head trauma during the fall has not been confirmed.”
Why it belongs: During an ongoing emergency, the history is limited to what is immediately available and relevant to treatment, not a complete narrative, and an unconfirmed detail should be named as unconfirmed rather than stated as a negative finding.
He's been shaking for a while now.
He has been continuously convulsing with no recovery of consciousness between movements.
Why: Naming the absence of recovery is the specific detail that confirms this is status epilepticus rather than repeated brief seizures.
Relevant background
Give only the background that changes immediate management
“He has known epilepsy, though his specific anti-seizure medication is not documented, and he has no other reported medical history.”
Why it belongs: Knowing he has epilepsy raises the likelihood of a breakthrough seizure from missed medication, but a longer social history can wait until he is stabilized.
He's an epileptic.
He has known epilepsy, though his current anti-seizure medication is not documented.
Why: Person-first language and naming what is unknown is more useful than a label alone.
Objective data
State vitals and the glucose result
“His vitals show a heart rate of 138, blood pressure 158 over 94, respiratory rate 22, temperature 38, and oxygen saturation 88% on room air. Point-of-care glucose is 104, ruling out hypoglycemia as the cause.”
Why it belongs: The low oxygen saturation confirms the airway and breathing need immediate attention, and the normal glucose excludes a rapidly reversible metabolic cause.
His oxygen is a bit low and his sugar is normal.
His oxygen saturation is 88% on room air, and his glucose is 104, ruling out hypoglycemia.
Why: Exact values let the team judge urgency instead of accepting a vague description.
Assessment
State the diagnosis without further discussion
“This is generalized convulsive status epilepticus in a patient with known epilepsy, and it needs immediate stepwise treatment rather than further diagnostic discussion right now.”
Why it belongs: In a true emergency the assessment is brief and directs the room toward action rather than exploring alternative diagnoses first.
This looks like a seizure that won't stop.
This is generalized convulsive status epilepticus and needs immediate stepwise treatment.
Why: Naming the diagnosis plainly tells the team to act now rather than deliberate.
Plan
State the exact step in the medication cascade
“Airway, oxygen, and glucose have already been addressed. I am giving IV lorazepam now as first-line therapy, and if the seizure continues past five minutes after this dose, I will move to a second-line agent such as levetiracetam, fosphenytoin, or valproic acid, with continuous EEG and ICU-level care if it persists further.”
Why it belongs: Naming the exact current step and the next step if it fails is what the team needs to track timing and avoid delay, which is the single most dangerous error in status epilepticus.
I'll give him a benzo and see how it goes.
I am giving IV lorazepam now, and if the seizure continues past five minutes, I will move to a second-line agent.
Why: Naming the specific drug class and the timed next step keeps the whole team synchronized.
Do not fill the blanks
Say what has not yet been established
Real presentations often happen before the chart is complete. A brief, explicit limitation is safer and more credible than a polished invention.
Exact anti-seizure medication and adherence
Say: “His specific anti-seizure medication and recent adherence are not documented in this simulation, and confirming them would help explain a breakthrough seizure.”
Missed doses of a known medication are a common and reversible trigger worth confirming once he is stabilized.
Anti-seizure drug level
Say: “A drug level for his usual medication is not available in this simulation and would help guide whether to reload his existing agent or add a new one.”
This decision should not be made without knowing his current level.
Clinical compression
What leads, what stays, and what can wait?
| Source detail | Decision | Reason |
|---|---|---|
| Continuous convulsive seizure for eight minutes with no recovery between movements | Lead | This single fact defines the diagnosis and the urgency of the entire presentation. |
| Known epilepsy, medication not documented | Include | It raises the likelihood of a breakthrough seizure but should not delay treatment. |
| Active lifestyle, non-smoker | Omit | This detail does not change emergency management and can wait indefinitely. |
| Oxygen saturation of 88% on room air | Lead | This is the vital sign that confirms an immediate airway and breathing concern. |
| Normal point-of-care glucose | Include | It rules out a rapidly reversible metabolic cause and should be stated, but briefly. |
After the presentation
Likely attending questions
Answer the question first, then give the evidence. If the source case does not contain the answer, say what you would verify.
Why give lorazepam before knowing his usual medication?
First-line benzodiazepine treatment does not wait for a full medication history, because the priority in status epilepticus is stopping the seizure quickly to prevent ongoing neuronal injury; his usual regimen can be clarified once he is stabilized.
What happens if the lorazepam doesn't work?
If the seizure continues past five minutes after the first-line dose, I would move to a second-line agent such as levetiracetam, fosphenytoin, or valproic acid, and escalate to continuous infusion anesthetics with ICU care if that also fails.
Why did you check glucose so early?
Hypoglycemia is a rapidly reversible cause of ongoing seizure activity, so checking it early both treats a possible cause immediately and clarifies the picture before further medications are given.
Self-check
A 30-second check before you present
- State the diagnosis and exact seizure duration in the first sentence.
- Keep the history brief and limited to what bystanders confirmed.
- State vitals and glucose without extra narrative.
- Name the current medication step, not just 'treating the seizure.'
- State the timed next step if the current treatment fails.
- Do not delay treatment to complete a full social or medication history.
- Mention airway and oxygenation status explicitly.
- Keep the entire presentation shorter than a routine new-patient presentation.
Common presentation problems
Repair the habits that make a case hard to follow
Giving a full standard history before starting treatment
Repair: State the diagnosis and start first-line therapy immediately, filling in history afterward.
Saying 'still seizing' without a timed next step
Repair: State exactly when you will escalate to the next medication if the current one fails.
Omitting oxygen saturation
Repair: State it explicitly, since airway and breathing take priority alongside seizure control.
Treating a normal glucose as reason to slow down
Repair: State that it rules out one reversible cause but does not change the urgency of ongoing treatment.
Frequently asked questions
Oral case presentation questions
How short can this presentation really be?
Shorter than almost any other case: diagnosis, duration, vitals, glucose, and current treatment step is enough in the acute moment; full history and background can follow once he is stabilized.
Do I need to name every drug in the cascade upfront?
Name the current step and the next one; naming every possible subsequent step in detail can wait unless directly asked.
Should I mention his epilepsy history first or the seizure duration first?
Lead with the diagnosis and duration, since that drives the timed treatment decision; the epilepsy history follows immediately after.
Practice out loud
Turn the patient encounter into your own presentation
Bedside English lets you interview an AI patient, then practice presenting the collected case to an AI attending and respond to follow-up questions.
Editorial record
Sources, provenance, and review boundary
The patient facts come from simulated case em_014. Clinical framing and presentation design were checked against the sources below. This page teaches clinical communication and reasoning; it is not medical advice or a local protocol.
- Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and AdultsAmerican Epilepsy Society · accessed 2026-09-03
- Feedback on Oral Presentations during RoundsStanford Medicine · accessed 2026-09-03
- Clinical Teaching Tools: OMP and SNAPPSUCSF Medical Education · accessed 2026-09-03
Published: · Last source, safety, and language review: