State of Wisconsin Emergency Medical Services

State of Wisconsin

Emergency Medical Services

Sample Medical Guidelines

Pediatric Seizure

Note:

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  Seizures usually last from 1-3 minutes and involve a loss of consciousness and convulsions. Not uncommonly, the patient is incontinent and may bite his tongue or be injured in other ways.
  
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  When the seizure is over, the patient enters a postictal state, characterized by confusion eventually giving way to normal alertness and orientation.
  
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  Whenever seizures occur, look for an underlying cause and treat it.
  
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  Status epilepticus is defined as a seizure lasting longer than 5minutes, or frequently recurring seizures without clearing of the postictal state between seizures. This is a life-threatening emergency!
  

Priorities	Assessment Findings
Chief Complaint	“Seizure” “Unresponsive” “Convulsions” “Passed out”
OPQRST	How long did it last? History of seizures? Possible contributing factors [1]
Associated Symptoms/ Pertinent Negatives	Unresponsive, Postictal, Incontinent
SAMPLE	History of seizures, Seizure medications?
Initial Exam	ABCs and correct any immediate life threats
Detailed Focused Exam	General Appearance: Pt. currently seizing? Unresponsive? Postictal? Resp: Airway Patent? Breathing? HEENT: Neck Stiff, pupils fixed and not reactive, eyes are deviating Skin: Flushed, warm, rash Neuro: ALOC?, Focal deficits (CVA)
Goals of Therapy	Stop the seizure Treat the underline cause Monitor and maintain airway.
Monitoring	BP, HR, RR, EKG, SpO2.

EMERGENCY MEDICAL RESPONDER (EMR)

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  Routine medical care
  
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  Consider oropharyngeal or nasopharyngeal airway, if the patient is unable to maintain a patent airway. Avoid attempting oral airway insertion during a seizure
  
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  Protect the patient with ongoing seizures from harming themselves by clearing away potential hazards and placing a pillow or padding under the head.
  
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  Oxygen as necessary
  

EMERGENCY MEDICAL TECHNICIAN (EMT)

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  Obtain blood glucose, if approved. If < 60 refer to Hypoglycemia Guidelines
  
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  Consider checking Temperature. If >100.6 F rectal. Report fever to Medical Control.
  
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  Consider Capnography if available
  

ADVANCED EMT (AEMT)

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  IV/IO NS TKO
  

Contact Medical Control for the following: Additional orders

INTERMEDIATE

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  If the patient is still seizing
  
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    No IV/IO Access give;
    
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      Midazolam (Versed) 0.1-0.2 mg/kg IN/IM. Max 10 mg.
      
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      May repeat in 5 minutes. Note IN/IM Versed should be 5mg/ml concentration.
      

or

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  Diazepam (Valium) rectally: 0.5 mg/kg <6 y/o; 0.3mg/kg 6-11 y/o; 0.2mg/kg >11y/o
  
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  May repeat in 10 minutes for continued seizure give 0.2 mg/kg/dose.
  
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  IV/IO access give;
  
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    Lorazepam (Ativan) 0.05-0.1mg/kg/dose up to 2 mg
    

or

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  Midazolam (Versed) 0.1-0.2 mg/kg IV. Max 10 mg.
  
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  May repeat in 5 minutes. Note IN/IM Versed should be 5 mg/ml concentration.
  
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  Intermediate agencies may have only one benzodiazepine on formulary
  
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  Continue to monitor airway since respiratory depression can result
  

Contact Medical Control for the following: If pseudoseizures are suspected, withhold medication until you speak with Medical Control.

PARAMEDIC

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  Alternative Benzodiazepines
  

Contact Medical Control for the following: Persistent seizures

Updated 1/2011

Origination 09/2008 Page of