The Twitching Tot

As he is being transferred to the resus trolley, you notice his eyebrows twitching. He is unresponsive, with eyes rolled back and both of his lower limbs soon begin jerking. HR 170, temperature 39.4^oC, O2 sats 98% on 10L/min oxygen. He is turned into the lateral position. His airway is patent, although with the seizure activity it is difficult to determine the rate and effort of breathing.

What is your initial management strategy for this patient?

Having given two doses of IV lorazepam and a phenytoin infusion commencing, his oxygen saturations drop to 90% on O2 15L/min. You suction his airway and apply a jaw thrust. He is not making any respiratory effort and is still seizing.

You are handed his venous blood gas:

pH 7.09
pCO2 11.7
pO2 10.7
Base Excess -6.3
Bicarb 19.2
Lactate 5.2
Glucose 8.6
Na 133
K 3.6

Please interpret the blood gas and outline your next steps in management.

In the event of delayed IV access, what are other options for administering medications?

Which anaesthetic agent/s would you choose for RSI?