1. Emergency Management of Seizures
Administration of Buccolam ® Midazolam Buccal Liquid

2. 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

3. 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

4. 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

5. 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

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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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

15. 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

16. 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

17. 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