Sandbox

Timeline	General Considerations	Seizure Treatment
0-5 minutes	"*Supportive care
*Check blood glucose
*Establish IV/IO access
*Acetaminophen 15 mg/kg rectally if fever"	"*Benzodiazepine: first dose
**IV/IO access establised
***Lorazepam 0.1 mg/kg IV or IO (max = 4 mg), OR
***Diazepam 0.2 mg/kg IV or IO, (max = 8 mg)
**IV or IO access not achieved within 3 minutes:
***Buccal midazolam 0.2 mg/kg (max = 10 mg), OR
**IM midazolam 0.1 to 0.2 mg/kg (max = 10 mg), OR
**Rectal diazepam (Diastat gel or injection solution given rectally) 0.5 mg/kg (max = 20 mg)"
5-10 minutes	*Give antibiotics if signs of sepsis or meningitis	*Benzodiazepine: second dose
10-15 minutes		"*Antiepileptic: first therapy
*Levetiracetam 40 mg/kg IV or IO, OR
*Fosphenytoin¶ 20 mg PE per kg IV or IO§, OR
*Valproate 20 to 40 mg/kg IV or IO, OR
*Phenobarbital 20 mg/kg IV or IO, maximum 1 g, (expect respiratory depression with apnea)¥"
15-30 minutes	"*Obtain pediatric neurology consultation
** In patients with ongoing seizure activity despite two initial doses of benzodiazepine and a second-therapy antiseizure drug, preparation for a continuous infusion of midazolam, propofol, or pentobarbital should occur simultaneously with administration of a third-therapy antiseizure drug."	"*Antiepileptic: second therapy
**Fosphenytoin¶ (if not already given) 20 mg PE per kg IV or IO◊, OR
**Valproate (if not already given) 20 to 40 mg/kg IV or IO, OR
**Phenobarbital (if not already given) 20 mg/kg IV or IO, maximum 1 g (10 mg/kg if phenobarbital already given)¥, OR
**Levetiracetam (if not already given) 40 mg/kg IV or IO,
*Consider pyridoxine if INH poisoning suspected
**Infants (<1 year): 100 mg IV or IO in
**Otherwise 70 mg/kg IV or IO (max = 5 g)"