• Identification of seizures in neonates and children can be difficult.  Signs of seizures can include rhythmic lip smacking, blinking, or “bicycle” movement of the legs.  Paramedics should treat ongoing seizures while considering reversible causes. 
• The primary concern in neonatal seizures is hypoglycemia, which should be identified and corrected with a 2 mL/kg D10W bolus until the blood glucose is greater than 2.6 mmol/L.  If IV access cannot be obtained, glucagon can be given intramuscularly (0.03 mg/kg).
• The preferred first line medication for control of a seizure lasting longer than 5 minutes, or multiple seizures without improving level of consciousness is a benzodiazepine.  Midazolam can be administered via the intranasal (IN), intravenous (IV) or intramuscular (IM) route.
  • IN 0.2 mg/kg
  • IV 0.15 mg/kg
  • IM 0.2 mg/kg

• If intractable seizure despite primary and secondary pharmacological treatment, critical care paramedics may consult with the transport advisor to consider:
  • a loading dose of midazolam 50 mcg/kg followed by an infusion beginning at 120 mcg/kg/hr and titrating to effect
  • a trial of Pyridoxine 50-100 mg over 1-2 minutes

• Patients requiring multiple sedatives or anti-convulsants have a high probability of requiring an advanced airway intervention and/or hemodynamic instability

Pediatric Seizure