Seizure Protocol
Management and status epilepticus treatment
HIGH PRIORITY
Initial Assessment
Safety First
- Move patient away from hazards
- Protect head with soft padding
- Do NOT restrain or put anything in mouth
- Turn patient on side if possible
Time Critical
- Note seizure start time
- >5 minutes = Status Epilepticus
- Monitor post-ictal period
- Document seizure characteristics
Active Seizure Management
0-5 Minutes
- • Protect from injury
- • High-flow oxygen
- • IV/IO access
- • Check blood glucose
5-10 Minutes
- • Midazolam 10mg IM or
- • Lorazepam 4mg IV/IO or
- • Diazepam 10mg IV/IO
- • Repeat in 5 min if needed
>10 Minutes
- • Status Epilepticus protocol
- • Consider intubation
- • Transport immediately
- • Consider phenytoin/fosphenytoin
Post-Ictal Management
Airway Management
- • Recovery position
- • Suction as needed
- • Supplemental oxygen
- • Monitor respiratory status
Neurological Assessment
- • GCS assessment
- • Pupil response
- • Motor function
- • Document recovery time
Monitoring
- • Continuous cardiac monitoring
- • Vital signs q5 minutes
- • SpO2 monitoring
- • Temperature check
Medication Quick Reference
Midazolam (IM)
Adult: 10mg IM
Peds: 0.2mg/kg (max 10mg)
Preferred if no IV access
Lorazepam (IV)
Adult: 4mg IV/IO
Peds: 0.1mg/kg (max 4mg)
May repeat x1 after 5 min
Diazepam (IV/PR)
Adult: 10mg IV/5-10mg PR
Peds: 0.2-0.5mg/kg
PR option if no IV
Transport Criteria
Immediate Transport
- • Status epilepticus
- • First-time seizure
- • Respiratory compromise
- • Pregnant patient
- • Head trauma
Consider Transport
- • Multiple seizures
- • Prolonged post-ictal
- • Medication non-compliance
- • No return to baseline
- • Patient/family request