FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- Base contact is required even if the seizure stops or the patient is not transported.
- Support ventilation and airway protection after medication; do not rely on cessation of visible motor activity alone.
Recognize the emergency
- Treat ongoing seizure activity or repeated episodes without recovery of consciousness. Turn to the side, protect the airway, and suction when possible.
- Status epilepticus includes a seizure longer than 5 minutes or repeated seizures without recovery. Subclinical activity can present with abnormal vital signs, gaze deviation, or a clenched jaw.
Midazolam by weight
- Preferred: 0.2 mg/kg IM once, maximum 10 mg.
- If IM cannot be delivered or IV/IO is already present: 0.1 mg/kg IN/IV/IO, maximum 5 mg. Repeat once after 3 minutes for continuing or recurrent seizures.
- Keep the preferred one-dose IM pathway distinct from the lower-dose alternate-route repeat pathway.
Oxygenation, ventilation & glucose
- Monitor SpO₂ and available waveform capnography. If room-air SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated.
- Assist with BVM when ETCO₂ is at least 50 mmHg.
- Check glucose: treat at or below 60 mg/dL, or use field impression at 60–80 when hypoglycemia is suspected. D10 is 5 mL/kg IV (maximum 250 mL); glucagon 0.5 mg IM if IV cannot be established. The IO dextrose exception requires unconsciousness, glucose below 60, no IV, and no response to glucagon.
Required contact & handoff
- Make base contact for every transported and non-transported pediatric seizure patient; pediatric-capable base preferred. Provide ALS escort to the nearest appropriate ERC.
- Report weight, seizure duration/pattern, recovery or persistent altered state, glucose, medication route/dose/time, and respiratory response.
VISUAL FIELD REFERENCE
Pediatric seizure: keep route-specific doses separate
Pediatric · ALS
For ongoing or recurrent seizure activity without recovery. Maximums and repeat instructions are part of each route.
- 0.2 mg/kg
Preferred IM pathway
Preferred: 0.2 mg/kg IM once, maximum 10 mg.
- 0.1 mg/kg
Alternative IN / IV / IO pathway
If IM cannot be delivered or IV/IO is already present: 0.1 mg/kg IN/IV/IO, maximum 5 mg. Repeat once after 3 minutes for continuing or recurrent seizures.
- Make base contact for every transported and non-transported pediatric seizure patient; pediatric-capable base preferred. Provide ALS escort to the nearest appropriate ERC.
- Support ventilation and airway protection after medication; do not rely on cessation of visible motor activity alone.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-P-075
UNDERSTAND THE CARE
Why seizure cessation and recovery are separate observations
The visible movements, return of consciousness and breathing response should be documented separately. The order includes ongoing seizures and repeated episodes without recovery; the reported duration and pattern help establish the clinical course. Obtain weight and any treatment given before arrival before preparing medication.
Applying the guidance
Keep the preferred IM regimen distinct from the alternate-route regimen. After treatment, monitor respiratory effort, oxygenation, available capnography and glucose findings as directed. A child who stops moving but remains altered still needs continued assessment. The contact requirement remains even when seizure activity has stopped or transport does not occur.
Putting it together
Teaching example: the convulsions stop after medication but the child remains poorly responsive with inadequate breathing. Document seizure cessation and the unresolved ventilatory problem separately while continuing support and base contact.
Diagram text & teaching checkpoints
- Pattern
- Duration and recovery between episodes.
- Preparation
- Weight, prior medication and selected route.
- Response
- Motor activity, consciousness and ventilation.
- Contact
- Required even after cessation or non-transport.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.