• Identification of seizures in neonates and children can be difficult.  Signs of seizures can include rhythmic lip smacking, blinking, or “bicycling” movement of the legs.  Paramedics and EMRs/FRs should manage 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 > 2.6 mmol/L.  If IV access is not within scope of practice or cannot be obtained, glucose gel can be given orally by rubbing on oral mucosa, or glucagon can be given intramuscularly (0.03 mg/kg).
• The preferred first line medication for control of a seizure lasting longer than five minutes, or multiple seizures without improving level of consciousness in between seizures, is a benzodiazepine.  Midazolam can be administered via the intranasal (IN), intravenous (IV), or intramuscular (IM) route at dosages of:
  • 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.

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Pediatric Seizure