History:

 

• Reported/witnessed seizure activity
• Previous seizure history
• Seizure medications
• History of recent head trauma
• Fever
• Congenital abnormality
• Consider pregnancy in teenage females

 

Significant Findings:

 

• Decreased mental status
• Sleepiness
• Observed seizure activity
• Hot, dry skin/hyperthermia

 

Differential:

 

• CNS (head) trauma
• Tumor
• Hypoxia/respiratory failure
• Drugs/medications
• Fever
• Infection
• Metabolic abnormality/acidosis

 

Treatment:

 

• • Oxygen

• • Consider 12-Lead EKG

• • Obtain BGL
  • Initiate IV

 

• • Midazolam (Versed) 0.1 mg/kg IM, Max 5 mg (if no IV/IO established)

 

• • • • • OR
        •  
  • Lorazepam (Ativan) 0.1 mg/kg IV slow; max 2 mg (if IV/IO established)

 

Still seizing ?

 

• Yes
• OLMC

 

• • Midazolam (Versed) 0.1 mg/kg IM, max dose 5 mg (Medical Control)
    • • • OR

 

• • Lorazepam (Ativan) 0.1 mg/kg IV; max 2 mg (Medical Control)

 

 

PEARLS:

• Pediatric = 1 day to less than age 12, or less than 55 kg in ages 12-18.
• Use Handtevy for drug dosages.
• Addressing the ABC's and verifying blood glucose is more important than stopping the seizure.
• Avoiding hypoxemia is extremely important.
• Abnormal eye movements are most common sign of seizures in neonates.
• Remember to look for evidence of trauma and treat accordingly.
• Status epilepticus is defined as two or more successive seizures without a period of consciousness or recovery.  This includes failure to return to consciouness greater than 5 minutes. This is a true emergency requiring rapid airway control, treatment, and transport.
• Grand mal seizures (generalized) are associated with loss of consciousness, incontinence, and tongue trauma.
• Focal seizures (petit mal) effect only a part of the body and do not usually result in a loss of consciousness.
• Jacksonian seizures are seizures, which start as a focal seizure and become generalized.
• Be prepared to assist ventilations especially if Midazolam (Versed) is used.
• If evidence or suspicion of trauma, spine should be immobilized.
• In an infant, a seizure may be the only evidence of a closed head injury.

• If family has Diastat on scene, Paramedics may give per medication instructions.