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2.19P                                Seizures - Pediatric                                         

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E/A

EMT/ADVANCED EMT STANDING ORDERS

  • Routine Patient Care.

  • If the blood glucose reading is <60mg/dl, see Hypoglycemia Protocol 2.10P.

  • Obtain the patient’s temperature for suspected febrile seizure (rectal route preferred, as appropriate).

  • Treat fever per Pediatric Color Coded Appendix A3.

  • If diazepam rectal gel (Diastat) has been prescribed by the patient’s physician assist the patient or caregiver with administration in accordance with physician’s instructions.

Click here for a video demonstrating administration of Diastat.

  • If the patient has an implanted vagus nerve stimulator (VNS), suggest that family use the VNS magnet to activate the VNS and assist if required.

    • To use the VNS magnet, pass the magnet closely over the VNS device; if unsuccessful, repeat every 3 – 5 minutes for a total of 3 times.

    • Note: do not delay medication administration.

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P

PARAMEDIC STANDING ORDERS

  • While seizure activity is present, consider:

    • *Midazolam 5mg/mL concentration (IM or IN preferred):

      • 0.2mg/kg IM/IN (single maximum dose 8mg) repeat every 5 minutes; or

      • 0.1mg/kg IV (single maximum dose 4 mg) repeat every 5 minutes, OR

    • Lorazepam 0.1mg/kg IV(single maximum dose 4mg) repeat every 5 minutes, OR

    • Diazepam 0.1mg/kg IV (single maximum dose 10mg IV) repeat every 5
      minutes.

*For IN administration of midazolam use a 5mg/mL concentration.

Do NOT routinely place an IV/IO for the actively seizing patient
(unless needed for other reasons)

PEARLS

  • Do not attempt to restrain the patient; protect them patient from injury.

  • History preceding a seizure is very important. Find out what precipitated the seizure (e.g., medication non-compliance, active infection, trauma, hypoglycemia, poisoning).

  • Status epilepticus is defined as any generalized seizures lasting more than 5 minutes. This is a true emergency requiring rapid airway control, treatment (including benzodiazepines), and transport.

  • IM/IN is the preferred route for midazolam where an IV has not been previously established.

  • IM midazolam should be administered to the lateral thigh.

  • Diazepam and lorazepam are not well absorbed IM and should be given IV.

  • There is an increase risk of apnea with >2 doses of benzodiazepines.

 

Protocol Performance Standards

Performance / DocumentationStandards

  • Was the patient's weight determined via weight-based resuscitation tape (unless weight definitively known)?

  • Was the correct weight-based dose of benzodiazepine administered?

  • Was medication administered within 5 minutes of arrival onscene?

  • Was the first dose of medication administered via the IM or the IN route?

  • Was the patient's blood glucose checked?

  • Was the patient's temperature taken?

Protocol Bibliography

Protocol Bibliography

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