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 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)