Pediatric Prehospital Seizure Management

Seizures are a common cause for activation of emergency medical services for pediatric patients, so utilization of best practices for the management of seizures is essential. Though similar in efficacy, midazolam and diazepam may be advantageous in comparison to lorazepam in the prehospital setting due to their longer shelf life. Obtaining vascular access may delay time to administration of treatment, so intranasal, intramuscular, or buccal routes should be used. Rectal medications are least preferred due to prolonged time to seizure cessation and more adverse effects. Though hypoglycemia is an infrequent cause of pediatric seizures, routine glucometry is recommended since benefits outweigh risks. More research is needed to determine optimal dosing and timing of medications, and to determine which non-intravenous routes of administration are preferable in the prehospital setting.