Page 50 - 2026 SMOG

SEIZURE
Signs and Symptoms Initial Treatment
• Decreased mental status • Provide oxygen support
• Seizure activity • Consider airway control (definitive if
• Somnolence necessary)
• Incontinence • Initiate IV/IO access
• Evidence of trauma • Place on cardiac monitor
• Loss of consciousness • Monitor blood glucose
• Oral injuries (e.g., tongue, buccal)
ADULT PEDIATRIC
• Active Seizure • Active Seizure
˚ Administer Midazolam 5mg IV/IO or ˚ Administer Lorazepam 0.1mg/kg IV
10mg IM
(max 4mg)
OR ■ May repeat once in 5–10min
OR
˚ Lorazepam 4mg IV/IM ˚ Midazolam 0.2mg/kg IN q15min or
OR
˚ Diazepam 5mg IV/IM 0.1–0.15mg/kg IM once (max dose 10mg)
TBI: Levetiracetam (Keppra) 60mg/kg,
May repeat anticonvulsants q5min if
■
seizure has not stopped ˚ single dose.
˚ Pregnancy considerations: • Blood Glucose <70mg/dL
Administer Magnesium Sulfate
Infants: 10% Dextrose 5–10mL/kg IV
■
4–6g IV over 15min (monitor for ˚ ˚ Children: 25% Dextrose 2–4mL/kg IV
hypotension) (max 25g/dose)
• Blood Glucose <70mg/dL OR
˚ Administer 50% Dextrose 25g IV ˚ Glucagon 0.5mg IM (<20kg); 1mg IM
(>20kg). May repeat in 15min
OR
˚ Glucagon 1mg IV/IM
Notes, Cautions, Warnings
• For seizure prophylaxis, consider Levetiracetam (Keppra) 1500mg IV over 15min, followed by
a maintenance dose of 1000mg q12hr
• Status epilepticus is defined as a seizure >15min or two or more continuous seizures without
a period of consciousness/recovery. This is a real emergency requiring rapid airway control,
treatment, and transport to the nearest suitable medical treatment facility.
• Paralysis for airway control does not stop seizure activity—only hides it. A seizure is a CNS
electrical phenomenon, and damage is still being done even when no muscular activity is seen
due to paralysis.
• In pregnant patients, Magnesium should be the first line to abort non-epileptic seizures. Use
Midazolam only if this fails.
• Be prepared to assist with ventilations with the use of Midazolam/Lorazepam.
Reference: CPG ID #30 (TBI Management & Basic Neurosurgery in a Deployed Environment), CPG ID #63
(TBI Management in PFC)

42 • MEDICAL