Inclusion Criteria: All patients actively seizing on EMS arrival, or who have a history of seizure lasting at least 5 minutes prior to EMS arrival. Guidelines are included for patients whose seizure stopped prior to EMS arrival.
NOTE: Consider alternative, organic explanations for seizures. (A-E-I-O-U-T-I-P-S; alcohol, epilepsy (or head injury), insulin (hypoglycemia), overdose, underdose/uremia, trauma, infection, psychosis, sepsis.)
Basic Level
Advanced Level
. . . the level of consciousness does not improve with oral glucose, or if oral glucose could not be given, administer:
At least 14 years of age
- Start IV/IO, and administer 50% dextrose, 50 mL (25 grams) IVP/IO;
- If symptoms and/or hypoglycemia persist after 10 minutes, administer an additional 25 grams (50 mL).
1 year to 13 years of age
- 25% dextrose 2 mL/kg IVP/IO (waste 25 mL of D50; replace with 25 mL Normal Saline).
- If symptoms and/or hypoglycemia persist after 10 minutes, administer an additional 2 mL/kg IVP/IO.
Less than 1 year of age
- 10% dextrose 5 mL/kg IVP/IO (waste 40 mL of D50; replace with 40 mL Normal Saline).
- Contact BioTel if additional dosing is required.
- Newborn under 1 month of age: administer only 2 mL/kg.
. . . IV or IO access cannot be obtained, administer:
At least 14 years of age
- Glucagon 1 mg IM/IN/SQ.
- May repeat once after 20 min.
1 year to 13 years of age
- Glucagon 1 mg IM/IN/SQ.
- May repeat once after 20 min.
Less than 1 year of age
- Glucagon 0.5 mg IM/IN/SQ.
- May repeat once after 20 min.
Adult
Pediatric
- Midazolam:
- INTRANASAL:
- 1-6 months old: 0.2 mg/kg to a maximum initial dose of 1 mg.
- More than 6 months old: 0.2 – 0.3 mg/kg to a maximum initial dose of 5 mg.
- Divide the dose between the two nostrils, if possible.
- INTRAVENOUS :
- 0.15 to 0.2 mg/kg to a maximum single initial dose of 5 mg.
OR
- Diazepam 0.5 mg/kg per rectum, single dose (Maximum 10 mg).\
- BioTel may order additional doses beyond standing order doses.
- Closely monitor for cardiorespiratory depression and prepare for assisted ventilation.
NOTE: Individual agencies may carry only one of these medications. They are not required to carry both.
For additional patient care considerations not covered under standing orders, consult BioTel.