Seizure

Inclusion Criteria: All patients actively seizing or who have a history of seizure prior to EMS arrival.

NOTE: Consider alternative explanations for seizures. (A-E-I-O-U-T-I-P-S; alcohol, epilepsy, insulin, overdose, underdose, trauma, infection, psychosis, sepsis.)

          Basic Level

1. Assess and support ABCs.
   
   
2. Place the patient in a position of comfort or in left lateral recumbent position facing the rescuers. If evidence of shock, place the patient supine with the feet elevated and monitor airway closely. Treat shock according to the Shock guidelines.
   
   
3. Administer oxygen as needed to maintain a SpO2 of at least 96%.
   
   
4. Perform fingerstick blood glucose analysis (BGA).
   a.   If patient is hypoglycemic AND can protect his or her airway, administer 1 tube oral glucose SL.
   b.   If symptoms persist after 10 minutes AND patient can protect his or her own airway, administer a second tube of oral glucose SL.
   
   
   Advanced Level
   
   
5. Consider establishing IV access at a TKO rate or use a saline lock. If the patient is hypotensive, treat according to the Shock Guidelines.
   
   
6. If actively seizing, administer an anticonvulsant until the seizure stops or maximum dose reached:

   Adult slow IVP diazepam in 2.5 mg - 5 mg increments (Max 10 mg) midazolam in 2.5 mg – 5 mg slow IVP (Max 5 mg) or intranasal (Max 10 mg)	Pediatric 0.5 mg/kg rectal diazepam (Max 10 mg)or 0.1 mg/kg intranasal midazolam (Max 10 mg)
   NOTE: Individual departments may carry only one of these medications; They are not required to carry both.

   
   
   
7. If the patient is hypoglycemic AND . . .
   
   . . . the level of consciousness does not improve with oral glucose, or if oral glucose could not be given, administer:

   Over age 12 years 50% dextrose, 50 ml (25 grams) IV push If symptoms and/or hypoglycemia persist after 10 minutes, administer an additional 25 grams

   1 Month to 12 years 2 mk/kg 25% dextrose IVP or IO (waste 25 ml of D50; replace with 25 ml NS) If symptoms and/or hypoglycemia persist after 10 minutes, administer an additional 2 ml/kg IV push

   Less than 1 month 5 ml/kg 10% dextrose IVP or IO (waste 40 ml of D50; replace with 40 ml NS)

   
   
   
   . . . IV or IO access cannot be obtained, administer:
   

   Over age 12 years glucagon 1 mg IM, IN, SQ

   1 Month to 12 years glucagon 1 mg IM, IN, SQ

   Less than 1 month glucagon 0.5 mg IM, IN, SQ

   
   
8. All patients under this guideline must have continuous cardiac monitoring and capnography.
   
   
9. For additional patient care considerations not covered under standing orders, consult BioTel.
   

<--back to table of contents