4-10 PEDIATRIC SEIZURES

EMR - Emergency Medical Responder

1. Establish patient responsiveness. If cervical spine trauma is suspected, manually stabilize the spine. Protect the patient from injury during involuntary muscular movements by ensuring scene safety.
2. Assess the patient’s airway of patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
3. Open the airway via chin lift or modified jaw thrust.
4. Suction as necessary
5. Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
6. Assess patient breathing, including mental status rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
7. If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a B-V-M device with 100% oxygen.
8. If breathing is adequate, place the child in a position of comfort and administer high-flow 100% oxygen as tolerated.
9. Assess circulation and perfusion.
10. Call for ALS intercept

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Assess patient breathing, including mental status, rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
2. Check blood glucose and if less than 60 mg/dL, treat per pediatric altered mental status / hypoglycemia protocol
3. Initiate transport and Contact MEDICAL CONTROL to discuss need for ALS intercept.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Assess patient breathing, including rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
2. Consider need for vascular access and administer NS at a TKO rate if indicated. If IV access unlikely or cannot be obtained in 2 attempts in a child less than 6 do not attempt further IV placement.
3. Contact MEDICAL CONTROL to discuss need for ALS intercept and for orders regarding rate of fluid administration.

Intermediate - Perform/Confirm All Above Interventions

1. If seizure activity continues or recurs, administer midazolam (Versed) 0.1 mg/kg IV/IO (max single dose 2 mg). May administer midazolam IN or IM if an IV is not available and the patient continues to seize.
2. Evaluate for need for endotracheal intubation.
3. Initiate transport.
4. If seizure activity continues 3 minutes after initial dose, repeat midazolam at the same dose and Contact MEDICAL CONTROL for further orders.

Paramedic - Perform/Confirm All Above Interventions