A 3-year-old boy is brought to ED by ambulance. He has been having a generalised tonic-clonic seizure for 12 minutes with no signs of stopping. He has no previous seizure history. No fever. Parents report he was well yesterday.
Observations:
- Temp 36.9°C, HR 158/min, RR 28/min, SpO₂ 94% on air
- Actively seizing, unresponsive, jaw clenched, eyes deviated to right
Paramedics have established IV access.
What is the most appropriate immediate management?
A
IV phenytoin 20mg/kg over 20 minutes
B
Rectal diazepam 5mg immediately
C
IV lorazepam 0.1mg/kg immediately
D
Await spontaneous cessation up to 20 minutes
E
Rapid sequence intubation immediately