# Seizure / convulsions

Treat active or recurrent seizures, monitor ventilation, and check for hypoglycemia.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked source for document revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/seizures/
Official source: [SO-M-040 — Seizure / Convulsions - Adult / Adolescent](https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-M-040%207-15-21.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- The preferred 10 mg IM regimen is a one-time dose; do not automatically repeat it.
- Anticonvulsant treatment can be followed by respiratory depression. Maintain airway and ventilation support.

## Source documents

- [SO-M-040 — Seizure / Convulsions - Adult / Adolescent](https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-M-040%207-15-21.pdf)

## When this treatment pathway applies

- Use for an ongoing seizure or repeated seizure activity without return of consciousness. Turn the patient to the side, protect the airway, and suction when necessary.
- Give the preferred IM medication before spending time establishing new vascular access.

## Midazolam

- Preferred: 10 mg IM once.
- If IM cannot be delivered, or IV/IO access is already present: 5 mg IV/IN/IO. May repeat once about 3 minutes later for continued or recurrent seizure activity.
- Contact base if seizure continues for 5 minutes after the first IM dose or second IV/IN/IO dose (a total of 10 mg by any route).

## Monitor oxygenation, ventilation & glucose

- Use SpO₂ and waveform capnography when available. For room-air SpO₂ below 95%, give high-flow mask oxygen or nasal cannula at 6 L/min as tolerated, watching for aspiration.
- If ETCO₂ is at least 50 mmHg, assist ventilation with BVM.
- Check glucose: treat at or below 60 mg/dL; the source also permits treatment at 60–80 when hypoglycemia is suspected. Use D10 up to 250 mL IV titrated to response, or glucagon 1 mg IM without IV access. Oral glucose requires consciousness and intact airway reflexes.

## Reassess & transport

- Reassess seizure activity, airway protection, ventilation, oxygenation, and mental status after treatment. Document dose/route/timing and glucose.
- Provide ALS transport to the nearest ERC, with base contact as indicated. The IO dextrose exception requires unconsciousness, glucose below 60, failed IV access, and no response to IM glucagon.