SEIZURE (PED)
ALL LEVELS
This protocol is intended for patients who are experiencing status epilepticus or recurrent seizures.
DESIGNATION OF CONDITION
Status epilepticus, the patient will be experiencing an active seizure when rescuers arrive, with a single episode of seizures lasting longer than 5 minutes, or 2 or more episodes of seizure activity between which the patient remains unconsciousness.
ALL LEVELS
1. Establish patient responsiveness/Assess mental status.
2. Protect the patient from injury during involuntary muscular movements.
3. Assess ABC’s
4. Consider placing an OPA or NPA if the airway cannot be maintained with positioning IF the patient is unresponsive consider LMA.
5. Suction as necessary
6. Obtain pulse oximeter reading.
7. If breathing is inadequate
a. Assist ventilation using a BVM device with high-flow, 100% concentration oxygen.
8. If abdominal distention arises, consider placing a nasogastric tube to decompress the stomach.
9. If breathing is adequate, place the child in a position of comfort and administer high-flow, 100% concentration oxygen as necessary. Use a non-rebreather mask or blow-by as tolerated.
10. Determine blood glucose level.
11. Assess temperature.
AEMT
1. If the patient is found to be febrile, cool the patient without overcooling.
2. If scene and transport time is greater than 20 minutes administer ACETOMINOPHEN 15 mg/kg orally
3. In-route, initiate an IV/IO of an isotonic solution at a TKO rate.
4. Initiate cardiac monitoring.
5. If blood glucose level is lower than 60 mg/dl or cannot be determined, administer intravenous dextrose as follows:
a. D10W at 5.0 ml./kg. of 250 ml. bag IV/IO titrated to patient condition
b. May be repeated x1 if BGL remains < 60 mg/dl or if the BGL cannot be determined and the patient is still in status epilepticus.
6. Repeat blood glucose level 1 to 2 minutes after DEXTROSE is administered.
PARAMEDIC
1. Administer MIDAZOLAM (0.2mg./kg.) IM to maximum of 10 mg. as a safe and effective route.
Alternatively (0.1 mg./kg.) IV/IO/IN to maximum of 4 mg.
Age Based Dose:
6-16 months 1.25 mg.
17 mo. to 5 years 2.5 mg.
6 – 11 years 5.0 mg.
12 and up years 10 mg.
2. Consider ETT placement if >12 y/o and meets other intubation criteria or SGA. LMA preferred.
a. Confirm placement with capnography
b. Maintain SpO2 >94%
ALL LEVELS
This protocol is intended for patients who are experiencing status epilepticus or recurrent seizures.
DESIGNATION OF CONDITION
Status epilepticus, the patient will be experiencing an active seizure when rescuers arrive, with a single episode of seizures lasting longer than 5 minutes, or 2 or more episodes of seizure activity between which the patient remains unconsciousness.
ALL LEVELS
1. Establish patient responsiveness/Assess mental status.
2. Protect the patient from injury during involuntary muscular movements.
3. Assess ABC’s
4. Consider placing an OPA or NPA if the airway cannot be maintained with positioning IF the patient is unresponsive consider LMA.
5. Suction as necessary
6. Obtain pulse oximeter reading.
7. If breathing is inadequate
a. Assist ventilation using a BVM device with high-flow, 100% concentration oxygen.
8. If abdominal distention arises, consider placing a nasogastric tube to decompress the stomach.
9. If breathing is adequate, place the child in a position of comfort and administer high-flow, 100% concentration oxygen as necessary. Use a non-rebreather mask or blow-by as tolerated.
10. Determine blood glucose level.
11. Assess temperature.
AEMT
1. If the patient is found to be febrile, cool the patient without overcooling.
2. If scene and transport time is greater than 20 minutes administer ACETOMINOPHEN 15 mg/kg orally
3. In-route, initiate an IV/IO of an isotonic solution at a TKO rate.
4. Initiate cardiac monitoring.
5. If blood glucose level is lower than 60 mg/dl or cannot be determined, administer intravenous dextrose as follows:
a. D10W at 5.0 ml./kg. of 250 ml. bag IV/IO titrated to patient condition
b. May be repeated x1 if BGL remains < 60 mg/dl or if the BGL cannot be determined and the patient is still in status epilepticus.
6. Repeat blood glucose level 1 to 2 minutes after DEXTROSE is administered.
PARAMEDIC
1. Administer MIDAZOLAM (0.2mg./kg.) IM to maximum of 10 mg. as a safe and effective route.
Alternatively (0.1 mg./kg.) IV/IO/IN to maximum of 4 mg.
Age Based Dose:
6-16 months 1.25 mg.
17 mo. to 5 years 2.5 mg.
6 – 11 years 5.0 mg.
12 and up years 10 mg.
2. Consider ETT placement if >12 y/o and meets other intubation criteria or SGA. LMA preferred.
a. Confirm placement with capnography
b. Maintain SpO2 >94%