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.

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.

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).

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 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.