Emergency Management of Seizures

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Emergency Management of Seizures

• Administration ofEpistatus Midazolam Buccal
  Liquid

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Learning Objectives

• To Develop an understanding of
• What Emergency Medication is and how it works
• When Emergency Medication is used in seizure
  activity
• The emergency action plan for epilepsy
• Demonstrate and describe the correct procedure
  for the safe and effective administration of
  Buccal Midazolam
• To recognise potential difficulties

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Emergency Medication

• Used to prevent epileptic seizures developing
  into status epilepticus
• Status epilepticus
• An epileptic seizure or series of seizures
  that continues for 30 minutes or more
• An alternative to rectal diazepam
• Prescribed on a named patient basis by consultant
  paediatrician, consultant neurologist or GP

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Status Epilepticus

• Term used to describe a single prolonged seizure
  lasting longer than 30 minutes
• Or
• Series of seizures which occur with no recovery
  in between
• Convulsive status is a medical emergency which
  requires urgent medical attention

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How Emergency Medication Works

• Passes across the mucosal membranes and is
  absorbed into the blood stream
• Travels directly to the brain
• Works at nerve cell junctions
• Reduces brain excitability
• Suppresses seizure activity
• Acts after approximately 5 minutes
• 80 seizures stop within 10 minutes
• Has a half life of 90 minutes
• Almost completely cleared from body within 6
  hours

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Side Effects of Epistatus

• Common side effects
• Severe Drowsiness
• Rare side effects
• Agitation
• Restlessness
• Disorientation

• Overdose call 999
• Excessive sleepiness
• Confusion
• Hypotension (low blood pressure)
• Shallow breathing
• Excitation

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Side Effects of Buccolam

• Common side effects
• Severe Drowsiness
• Nausea Vomiting
• Shallow Breathing

• Rare side effects
• Rash

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When to give Emergency Medication

• Children with epilepsy who require the
  administration of emergency medication should
  have an individual Emergency Seizure Management
  Plan
• As stated on childs individual Seizure
  Management Plan (Page 2)
• Action plan should include
• Usual seizure pattern what happens before,
  during and after a seizure
• Known triggers
• Individual emergency protocol for child
• When to give emergency medication
• Dose of Emergency Medication
• If and when a second dose can be given
  (individually assessed)
• When to call paramedic services

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Storage of Emergency Medication

• Store at room temperature in a locked cupboard
• Emergency Medication should be stored with the
  Emergency Seizure Management Plan.

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Administration of Emergency Medication(Between
teeth and gums)

• Equipment required
• Prescribed Emergency Medication
• Emergency Seizure Management Plan
• Tissues
• Check
• Childs airway, if no obvious problem with airway
  proceed
• Childs identity, medication and drug dosage with
  Emergency Seizure Management Plan
• Expiry date of Emergency Medication
• If possible place the child on their side

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Epistatus

• Remove the bottle and syringe from the box
• Hold the bottle upright
• Remove the child resistant cap by pushing down
  and turning anti-clockwise
• Insert the tip of the syringe into the hole in
  the white plastic bottle adaptor
• Hold the bottle and syringe securely and tip
  upside down allowing the gel to run to the top of
  the bottle
• Pull the syringe out slowly until the syringe
  contains the prescribed amount of Buccal
  Midazolam as per childs Seizure Management Plan
• Turn the bottle upright and remove syringe from
  the bottle
• Replace cap on bottle immediately

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If child is seated and has no head support on
their chair Support the childs head by standing
behind them holding their chin Be careful not to
press on the childs throat If childs head is
supported hold chin to keep their head steady

• Gently open the childs mouth by holding their
  chin and gently applying downward pressure on
  their lower lip

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Insert the syringe horizontally into the back of
the childs lower gums and cheek To locate the
Buccal cavity gently tilt the syringe
upwards Very slowly administer half the liquid
Repeat the process in the opposite cavity If the
child is lying on their side, insert all the
Epistatus into the lower side. Gentle hold
lips shut for approximately 30 seconds Record
time Epistatus was administered Place in the
recovery position as soon as possible
If there is excess salivation Buccal Midazolam
can be administered into each nostril
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BUCCOLAM

• The full amount of solution should be inserted
  slowly into the space between the gum and the
  cheek
• Can be administered while the patient is lying
  on his/her back or in a seated position
• If necessary (for larger volumes of BUCCOLAM
  and/or smaller patients), approximately half the
  dose should be given slowly into one side of the
  mouth, then the other half given slowly into the
  other side

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What to do if Emergency Medication
isIneffective

• Staff/Carers should only administer a single dose
  of Emergency Medication
• If the seizure has not stopped within 10 minutes
  after administration of Emergency Medication,
  dial 999 and seek emergency medical assistance.
• Provide the empty Buccolam syringe to the
  Emergency Health Professional to provide
  information on the dose received by the patient

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After Care

• Observe child
• Breathing colour
• Progress of seizure
• Response to medication
• Initial effect in approximately 5 minutes
• 80 of seizures stop within 10 minutes
• Any injuries
• Remain with child reassure
• Dispose of equipment safely
• Wash hands
• Inform parents/carers as per seizure management
  plan

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Call an Ambulance if

• You think the pupil needs urgent medical
  assistance
• The seizure does not stop following
  administration of all prescribed emergency
  medication as per emergency seizure management
  plan
• The child does not regain consciousness following
  the seizure
• It is the first time Emergency Medication has
  been administered to child
• Any difficulty in breathing following seizure
• Child is injured during the seizure
• Indicated on Emergency Seizure Management Plan

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Record Keeping

• Record
• Date and time drug was administered on record
  sheet
• In childs notes home diary
• Why drug was given
• How long seizure lasted
• How many seizures occurred
• Details of what occurred before, during and after
  seizure
• After the incident a debriefing session should
  take place with all staff involved

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