To Develop an understanding of



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tarix21.04.2017
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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

  • 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



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





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