Sandbox

Timeline	General Considerations	Seizure Treatment
0-5 minutes	Supportive care Establish IV/IO access Check blood glucose If fever, acetaminophen 15 mg/kg rectally	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 POC electrolytes, if available	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	Consider intubation, if not already performed Pediatric neurology consultation	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 lready 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)

^May be ineffective for toxin-induced seizures and contraindicated in cocaine toxicity