A 34-year-old woman is brought to the Emergency Department actively seizing. Paramedics gave a single dose of buccal midazolam 10mg at 10 minutes with no response. The time from seizure onset is now 18 minutes. She has known epilepsy but is reportedly non-compliant with her phenytoin. IV access has been established. Blood glucose is 5.8 mmol/L.
Observations: HR 128/min, BP 156/98 mmHg, SpO₂ 91% on 15L oxygen, temperature 37.2°C.
What is the MOST appropriate immediate next step?
A
Proceed immediately to rapid sequence intubation
B
Administer IV lorazepam 4mg bolus
C
Administer IV phenytoin 20mg/kg infusion
D
Administer IV levetiracetam 60mg/kg over 10 minutes
E
Administer rectal diazepam 10-20mg