- Assess and treat ABC's
- Consider use of nasopharyngeal airway or oropharyngeal airway.
- Assist respirations with bag-valve-mask as needed.
- Consider endotracheal intubation if apneic or unable to protect airway (see Intubation/RSI)
- Consider IO placement if unable to successfully place peripheral IV
- Consider and treat underlying cause of seizure activity
- Events preceding and description of the seizure
- Electrolyte and glucose levels
- Traumatic events (consider c-spine immobilization)
- Exposure to toxins
- Neurological problems
- Recent febrile illness
- Obtain labs as appropriate. Consider glucose, electrolytes, ABG and blood cultures
- Avoid continued use of neuromuscular blocking agents as they are not anticonvulsants and will mask clinical seizures.
- Protect from external stimuli such as excessive noise, strobe effect, etc.
- Lorazepam (Ativan): I.V. 0.1 mg/kg (max single dose= 4 mg) IV push over 2-5 minutes. May repeat in 10-15 minutes to a max total dose of 8 mg in 12 hr
- Consider loading with longer acting anticonvulsant
- Fosphenytoin (Cerebyx)
- The dose, concentration in solutions, and infusion rates for Fosphenytoin are expressed as Phenytoin Sodium equivalents (PE).
- Consider loading dose: IV 15-20mg PE/kg I.V. administered at 100-150mg PE/min. Do not administer at a rate faster than 150 PE mg/ml.
- 15-20 mg/kg; may repeat dose after 20 minutes (maximum total dose 40mg/kg).
- Keppra (Levetiracetam): 60 mg/kg IV loading dose (up to 4500 mg)
- New guideline for treatment of prolonged seizures in children and adults- 02/2016.