Template:Seizure actively seizing management

• Protect patient from injury
  • If possible, place patient in left lateral position to reduce risk of aspiration
  • Do not place bite block!
• Benzodiazepine (Initial treatment of choice)
  • Midazolam IM 10mg (>40kg), 5mg (13-40kg), or 0.2mg/kg - may also be given IN
  • Lorazepam IV 2mg or 0.1mg/kg
  • Diazepam IV 0.15-0.2mg/kg (up to 10mg) or PR 0.2-0.5mg/kg (up to 20mg)
• Secondary medications
  • Fosphenytoin IV 20-30mg/kg at 150mg/min (may also be given IM)
    • Contraindicated in pts w/ 2nd or 3rd degree AV block
  • Valproic acid IV 20-40mg/kg at 5mg/kg/min
  • Levetiracetam IV 60mg/kg, max 4500mg/dose
  • Phenobarbital IV 20mg/kg at 50-75mg/min (be prepared to intubate)
• Refractory medications
  • Propofol 2-5mg/kg, then infusion of 2-10mg/kg/hr OR
  • Midazolam 0.2mg/kg, then infusion of 0.05-2mg/kg/hr OR
  • Ketamine loading dose 0.5 to 3 mg/kg, followed by infusion of 0.3 to 4 mg/kg/hr
  • Consider consulting anesthesia for inhaled anesthetics (potent anticonvulsants)
• Consider
  • Secondary causes of seizure (e.g. hyponatremia, hypoglycemia, INH toxicity, ecclampsia)
  • Nonconvulsive seizures or status epilepticus - get EEG