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Emergency drug and fluid calculator
Unprovoked seizures are common in children with around 8% having a seizure by 15 years of age. Most seizures are brief and self-limiting, generally ceasing within 5 minutes.
Seizures should be treated immediately in the following situations (see flowchart below):
Assessment and management should occur concurrently if the child is actively seizing.
considerations in acute assessment
Detailed chronological history of events and behaviours before, during and after the seizure
History should be taken from the child if possible and obtain bystander account
In most situations, observation for 5 minutes is appropriate whilst waiting for seizure to stop spontaneously
Treat the child the way the parents will at home – keep safe and observe
At this stage there is no need to check oximetry or apply oxygen
Active seizure flowchart
used in acute seizures
0.1 mg/kg IV/IM (max 10 mg)
0.3 mg/kg buccal/IN (max 10 mg)
IV dose preferable
Do not give IM
20 mg/kg IV/IO
Infuse undiluted into a large vein over 20 min (max rate 50 mg/min) in a monitored patient
Do not give in age
Dilute to 20 mg/mL or weaker and infuse over 20 mins (max rate 30 mg/min) in a monitored patient.
Stop infusion when seizure ceases
Commonly used in
For refractory seizures requiring rapid sequence induction and ventilation. Use only with involvement of senior staff confident with airway management. Beware hypotension.
Position child in recovery position, maintain airway Monitor for further seizure activity Consider investigations as appropriate
Blood glucose should be performed as soon as possible
Consider electrolytes, calcium and venous gas in the following circumstances:
Consider in the following circumstances:
Consider admission for observation in children
Children anticipated to require ICU level care (cardiorespiratory compromise).
For emergency advice
and paediatric or neonatal ICU transfers, see Retrieval Services.
In older children, when the child is back to baseline function with no red flags on history, examination or presumed cause
All families should receive education prior to discharge which includes:
Health Info (Vic)
Seizures – safety issues and how to help Epilepsy Midazolam for seizures Electroencephalography
PENNSW First seizure pack and video
Last updated August 2020