You arrive at the address where the parents show you into the living room where the child is on the floor, having a tonic clonic seizure. The parents explain last year the child was involved in an accident and suffered a traumatic brain injury. Since then he has had seizures at random. They normally only last a few minutes, but this one has been going for 20 minutes. Looking at the patient, you can see that they are blue in the face with ashen coloured skin.

For the amount of time the patient has been fitting, what emergency status are they in

The patient is lying on their left side with a blue face and fitting ongoing. What deficit are you going to manage first

You go to the patient’s head and can hear grunting sounds every time he breathes in. You try to open the airway but the mouth is shut tight with trismus. What airway can you use for this situation

You place a NPA and O2 mask on the patient. You ask the parents if they have given an anti-convulsant, which they say no. Aware that the convulsive state will continue to affect the patient’s airway and breathing, you look to administer buccal midazolam. The parents aren’t aware of any procedures of convulsion plans for their child, and cannot tell you what his usual recommended dose is. What amount are you going to give

You administer the medication and await its’ effect. While waiting, you prepare airway and breathing kit, and maintain the lateral position of the patient. What is the dose interval of buccal midazolam

You continue to do what you can, taking temperature and blood sugar which return normal. After 5 minutes, the patient’s convulsing stops and they don’t seem to be breathing. You can feel a pulse, but confirm no respiratory effort. What actions will you take next

You start ventilating the patient but find some resistance. The trismus has eased but there is still some airway difficulty. You still have the NPA in place and try airway manoeuvres, what other airway adjunct in the stepwise approach can you look at next

Placing an OPA helps with the resistance and you are now able to effectively ventilate the patient. You hear the ambulance pulling up outside, and 2 paramedics enter the house. You handover to them the events and your treatment given. You stay on the airway and breathing while the crew move the patient into the ambulance. The patient remains in an unconscious state with required ventilations. What pre-alert tool can you use for the accepting hospital