In a patient with status epilepticus, which action should be prioritized first?

• A. Establish an airway
• B. Call rapid response
• C. Administer IV antibiotics
• D. Elevate legs

Answer: (A)

Securing the airway is the immediate priority in status epilepticus. When a seizure is prolonged, protective airway reflexes can be lost, secretions and tongue obstruction may occur, and the risk of hypoxia or aspiration rises quickly. By establishing a patent airway and delivering oxygen, you ensure the patient can be ventilated and that life-saving medications can be given without delay. Practical steps include careful positioning to protect the airway, suctioning secretions, avoiding anything forced into the mouth, and providing high-flow oxygen while preparing for definitive airway support if needed. Once the airway is secured, you can then focus on breathing and circulation and treatment of the seizure itself. Calling for help is essential, but it doesn’t address the immediate danger of an unsecured airway.