To Develop an understanding of

To Develop an understanding of

• To Develop an understanding of

• What Emergency Medication is and how it works
• When Emergency Medication is used in seizure activity
• The emergency action plan for epilepsy

• Demonstrate and describe the correct procedure for the safe and effective administration of Buccal Midazolam

• To recognise potential difficulties

• Used to prevent epileptic seizures developing into status epilepticus

• Status epilepticus

• An epileptic seizure or series of seizures that continues for 30 minutes or more

• An alternative to rectal diazepam

• Prescribed on a named patient basis by consultant paediatrician, consultant neurologist or GP

Term used to describe a single prolonged seizure lasting longer than 30 minutes

• Term used to describe a single prolonged seizure lasting longer than 30 minutes

• Or

• Series of seizures which occur with no recovery in between

• Convulsive status is a medical emergency which requires urgent medical attention

Passes across the mucosal membranes and is absorbed into the blood stream

• Passes across the mucosal membranes and is absorbed into the blood stream

• Travels directly to the brain

• Works at nerve cell junctions

• Reduces brain excitability
• Suppresses seizure activity

• Acts after approximately 5 minutes

• 80% seizures stop within 10 minutes

• Has a half life of 90 minutes

• Almost completely cleared from body within 6 hours

Common side effects

• Common side effects

• Severe Drowsiness

• Rare side effects

• Agitation
• Restlessness
• Disorientation

Common side effects

• Common side effects

• Severe Drowsiness
• Nausea & Vomiting
• Shallow Breathing

Children with epilepsy who require the administration of emergency medication should have an individual Emergency Seizure Management Plan

• Children with epilepsy who require the administration of emergency medication should have an individual Emergency Seizure Management Plan

• As stated on child’s individual Seizure Management Plan (Page 2)

• Action plan should include

• Usual seizure pattern – what happens before, during and after a seizure
• Known triggers
• Individual emergency protocol for child
• When to give emergency medication
• Dose of Emergency Medication
• If and when a second dose can be given (individually assessed)
• When to call paramedic services

• Store at room temperature in a locked cupboard
• Emergency Medication should be stored with the Emergency Seizure Management Plan.

Equipment required

• Equipment required

• Prescribed Emergency Medication
• Emergency Seizure Management Plan
• Tissues

• Check

• Child’s airway, if no obvious problem with airway proceed
• Child’s identity, medication and drug dosage with Emergency Seizure Management Plan
• Expiry date of Emergency Medication

• If possible place the child on their side

Remove the bottle and syringe from the box

• Remove the bottle and syringe from the box

• Hold the bottle upright
• Remove the child resistant cap by pushing down and turning anti-clockwise
• Insert the tip of the syringe into the hole in the white plastic bottle adaptor

• Hold the bottle and syringe securely and tip upside down allowing the gel to run to the top of the bottle

• Pull the syringe out slowly until the syringe contains the prescribed amount of Buccal Midazolam as per child’s Seizure Management Plan
• Turn the bottle upright and remove syringe from the bottle
• Replace cap on bottle immediately

The full amount of solution should be inserted slowly into the space between the gum and the cheek

• The full amount of solution should be inserted slowly into the space between the gum and the cheek

• Can be administered while the patient is lying on his/her back or in a seated position

• If necessary (for larger volumes of BUCCOLAM and/or smaller patients), approximately half the dose should be given slowly into one side of the mouth, then the other half given slowly into the other side

Staff/Carers should only administer a single dose of Emergency Medication

• Staff/Carers should only administer a single dose of Emergency Medication

• If the seizure has not stopped within 10 minutes after administration of Emergency Medication, dial 999 and seek emergency medical assistance.

• Provide the empty Buccolam syringe to the Emergency Health Professional to provide information on the dose received by the patient

Observe child

• Observe child

• Breathing & colour
• Progress of seizure
• Response to medication
• Initial effect in approximately 5 minutes
• 80% of seizures stop within 10 minutes
• Any injuries
• Remain with child & reassure
• Dispose of equipment safely
• Wash hands
• Inform parents/carers as per seizure management plan

You think the pupil needs urgent medical assistance

• You think the pupil needs urgent medical assistance

• The seizure does not stop following administration of all prescribed emergency medication as per emergency seizure management plan

• The child does not regain consciousness following the seizure

• It is the first time Emergency Medication has been administered to child

• Any difficulty in breathing following seizure

• Child is injured during the seizure

• Indicated on Emergency Seizure Management Plan

Record

• Record

• Date and time drug was administered on record sheet
• In child’s notes & home diary
• Why drug was given
• How long seizure lasted
• How many seizures occurred
• Details of what occurred before, during and after seizure

• After the incident a debriefing session should take place with all staff involved