Emergency Management of Seizures Administration of Buccolam ® Midazolam Buccal Liquid

Learning Objectives To Develop an understanding of : What Emergency Medication is and how it works When Emergency Medication is used in seizure activity The emergency action plan for epilepsy Demonstrate and describe the correct procedure for the safe and effective administration of Buccal Midazolam To recognise potential difficulties

Emergency Medication Used to prevent epileptic seizures developing into status epilepticus An alternative to rectal diazepam Prescribed on a named patient basis by consultant paediatrician, consultant neurologist or GP

Status Epilepticus Status epilepticus is the term used to describe a single prolonged seizure lasting longer than 30 minutes Or A series of seizures which occur with no recovery in between. Convulsive status is a medical emergency which requires urgent medical attention

How Emergency Medication Works Passes across the mucosal membranes and is absorbed into the blood stream Travels directly to the brain Works at nerve cell junctions to: Reduce brain excitability Suppress seizure activity Acts after approximately 5 minutes 80% seizures stop within 10 minutes Has a half life of 90 minutes Almost completely cleared from body within 6 hours

Side Effects of Buccolam Common side effects Severe Drowsiness Nausea & Vomiting Shallow Breathing Rare side effects Rash

When to give Emergency Medication Children with epilepsy who require the administration of emergency medication should have an individual Emergency Seizure Management Plan Action plan should include: Usual seizure pattern – what happens before, during and after a seizure Known triggers Individual emergency protocol for child When to give emergency medication Dose of Emergency Medication If and when a second dose can be given (individually assessed) When to call paramedic services

Storage of Emergency Medication Store at room temperature in a locked cupboard Emergency Medication should be stored with the Emergency Seizure Management Plan.

Administration of Emergency Medication (Between teeth and gums) Equipment required Prescribed Emergency Medication Emergency Seizure Management Plan Tissues Check Child’s airway, if no obvious problem with airway proceed. Child’s identity. Medication and drug dosage with Emergency Seizure Management Plan Expiry date of Emergency Medication If possible place the child on their side

If child is seated and has no head support on their chair Support the child’s head by standing behind them holding their chin Be careful not to press on the child’s throat If child’s head is supported hold chin to keep their head steady Gently open the child’s mouth by holding their chin and gently applying downward pressure on their lower lip

Gentle hold lips shut for approximately 30 seconds Insert the syringe horizontally into the back of the child’s lower gums and cheek. To locate the Buccal cavity gently tilt the syringe upwards Very slowly administer half the liquid Repeat the process in the opposite cavity If the child is lying on their side, insert all the Epistatus into the lower side. Gentle hold lips shut for approximately 30 seconds Record time Epistatus was administered. Place in the recovery position as soon as possible If there is excess salivation Buccal Midazolam can be administered into each nostril

BUCCOLAM The full amount of solution should be inserted slowly into the space between the gum and the cheek Can be administered while the patient is lying on his/her back or in a seated position If necessary (for larger volumes of BUCCOLAM and/or smaller patients), approximately half the dose should be given slowly into one side of the mouth, then the other half given slowly into the other side

What to do if Emergency Medication is Ineffective Staff/Carers should only administer a single dose of Emergency Medication. If the seizure has not stopped within 5 minutes after administration of Emergency Medication, dial 999 and seek emergency medical assistance. Provide the empty Buccolam syringe to the Emergency Health Professional to provide information on the dose received by the patient

After Care Observe child Breathing & colour Progress of seizure Response to medication Initial effect in approximately 5 minutes 80% of seizures stop within 10 minutes Any injuries Remain with child & reassure Dispose of equipment safely Wash hands Inform parents/carers as per seizure management plan

Call an Ambulance if …… You think the child/young person needs urgent medical assistance The seizure does not stop following administration of all prescribed emergency medication as per emergency seizure management plan The child does not regain consciousness following the seizure It is the first time Emergency Medication has been administered to child Any difficulty in breathing following seizure Child is injured during the seizure Indicated on Emergency Seizure Management Plan

Record Keeping Record Date and time drug was administered on record sheet In child’s notes & home diary Why drug was given How long seizure lasted How many seizures occurred Details of what occurred before, during and after seizure After the incident a debriefing session should take place with all staff involved