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Emergency Management of Seizures
Administration of Epistatus ® Midazolam Buccal Liquid
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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
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Emergency Medication Used to prevent epileptic seizures developing into status epilepticus Status epilepticus An epileptic seizure or series of seizures that continues for 30 minutes or more An alternative to rectal diazepam Prescribed on a named patient basis by consultant paediatrician, consultant neurologist or GP
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Status Epilepticus Term used to describe a single prolonged seizure lasting longer than 30 minutes Or Series of seizures which occur with no recovery in between Convulsive status is a medical emergency which requires urgent medical attention
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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 Reduces brain excitability Suppresses 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
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Side Effects of Epistatus
Common side effects Severe Drowsiness Rare side effects Agitation Restlessness Disorientation Overdose – call 999 Excessive sleepiness Confusion Hypotension (low blood pressure) Shallow breathing Excitation
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Side Effects of Buccolam
Common side effects Severe Drowsiness Nausea & Vomiting Shallow Breathing Rare side effects Rash
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When to give Emergency Medication
Children with epilepsy who require the administration of emergency medication should have an individual Emergency Seizure Management Plan As stated on child’s individual Seizure Management Plan (Page 2) 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
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Storage of Emergency Medication
Store at room temperature in a locked cupboard Emergency Medication should be stored with the Emergency Seizure Management Plan.
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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
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Epistatus Hold the bottle upright
Remove the bottle and syringe from the box Hold the bottle upright Remove the child resistant cap by pushing down and turning anti-clockwise Insert the tip of the syringe into the hole in the white plastic bottle adaptor Hold the bottle and syringe securely and tip upside down allowing the gel to run to the top of the bottle Pull the syringe out slowly until the syringe contains the prescribed amount of Buccal Midazolam as per child’s Seizure Management Plan Turn the bottle upright and remove syringe from the bottle Replace cap on bottle immediately
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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
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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
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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
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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 10 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
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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
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Call an Ambulance if …… You think the pupil 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
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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
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