IBSC Certified Critical Care Paramedic (CCP-C) Practice Test

When a generalized tonic-clonic seizure persists after benzodiazepines in a critically ill patient, the priority is to secure the airway and ensure adequate oxygenation and ventilation, because ongoing convulsions and sedation can lead to hypoxia and worsening metabolic derangements. After ensuring the airway, administer a second-line intravenous antiepileptic such as fosphenytoin/phenytoin or levetiracetam to stop the seizure and reduce the likelihood of recurrence, while continuing to monitor the patient closely. At the same time, actively identify and treat possible underlying causes—check glucose and correct hypo- or hyperglycemia, assess and correct electrolyte disturbances (especially sodium, calcium, and magnesium), and evaluate for infections, toxins, stroke, or other intracranial events. Repeat metabolic labs and arterial blood gases to guide further treatment. Maintain airway protection and ongoing metabolic checks as you pursue definitive care, and escalate to deeper sedation and continuous monitoring if seizures remain uncontrolled per protocol.