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Questions and Answers
What is the maximum dose of Midazolam for IM administration in pediatric patients?
When administering oxygen to a pediatric patient, what is the target SpO2 level that should be maintained?
What should be initiated if a pediatric patient exhibits continuous seizures after Midazolam administration and IV access is available?
Which of the following treatments is NOT indicated for managing a pediatric patient's seizure if they are self-limited?
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In the event of a recognized shortage of Midazolam, which alternative medication can be used for seizure control?
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Which intervention is essential to avoid during transportation of pediatric patients?
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What should be administered if a pediatric patient's blood glucose is ≤ 60 mg/dl?
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Which of the following is NOT a condition for administering Midazolam to a pediatric patient experiencing seizures?
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Which treatment should be initiated for a pediatric patient exhibiting continuous seizure activity while IV access is available?
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When can Diazepam be used as a substitute for Midazolam in pediatric seizure management?
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To manage blood glucose levels in pediatric patients, if the blood sugar is ≤ 60 mg/dl, treat per PD# ______.
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For continuous seizure activity, administer Midazolam via the ______ route as the preferred method.
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If the patient exhibits fever causing a seizure, it's essential to check the ______ and begin cooling measures.
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Continuous seizures require initiating vascular access with ______ to stabilize the patient's blood pressure.
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Study Notes
Pediatric Seizures
- Maintaining temperature in prehospital settings is crucial for pediatric patients.
- Temperatures below 37°C (98.6°F) are associated with increased mortality.
- Simple interventions can help prevent hypothermia and reduce mortality.
- During transport, ensure the patient's temperature is within the normal range.
- Avoid hyperthermia.
Prehospital Treatment
- Perform a blood glucose determination.
- Supplemental oxygen is used to maintain SpO2 ≥ 94%.
- Use the lowest possible oxygen concentration and flow rate.
- Airway adjuncts are used as needed.
- Apply spinal motion restriction if indicated.
- Protect the patient from further injury.
- Check the patient's temperature.
- If the seizure is caused by fever, initiate cooling measures.
- Transport the patient to the hospital.
Advanced Life Support (ALS) Treatments
- Airway adjuncts are used as needed.
- Treat hypoglycemia (blood sugar ≤ 60 mg/dl) according to protocol PD# 9007 – Pediatric Diabetic Emergencies.
- If seizure activity has stopped and the level of consciousness is improving or stable, continue transport.
- For continuous seizures, administer Midazolam (IM/IN preferred):
- IM: 0.1 mg/kg (max dose 4 mg)
- IN: 0.2 mg/kg (max dose 6.0 mg)
- IV: 0.1 mg/Kg (max dose 4 mg) slow IV push in 1-2 mg increments, titrate to seizure control.
- Monitor the patient's cardiac rhythm.
- If seizures persist, initiate vascular access with NS, titrate to a minimal SBP for the patient's age.
Alternatives to Midazolam
- Diazepam can substitute Midazolam in case of shortage.
- Diazepam dosage: 0.1mg/kg IV/IO to control seizures.
- If IV access is unavailable, administer Diazepam 0.1mg/kg IM.
- May repeat Diazepam IM dose once.
- Maximum Diazepam dose is 5 mg.
Seizure Management Considerations
- Many seizures resolve before medication administration.
- Midazolam should be administered only for continuous seizures and in specific cases:
- History of non-febrile seizures.
- Respiratory compromise.
- Emesis (vomiting).
- Follow the hospital's orders for any additional indications for medication administration.
Pediatric Seizures Treatment
- Hypothermia can be deadly in children.
- Maintain normal body temperature during transport, using warming measures.
- Blood glucose should be checked.
- Oxygen should be provided if needed to maintain SpO2 ≥ 94% at the lowest concentration and flow rate possible.
- BLS treatments include airway adjuncts, spinal motion restriction when indicated, protecting the patient from further injury, and checking temperature and initiating cooling measures if fever is the cause of the seizure.
- ALS treatments include airway adjuncts, treatment for low blood sugar (< 60 mg/dl) per protocol, continuous transport if seizure activity has stopped and the level of consciousness is improving or remaining constant, and cardiac monitoring.
- Midazolam is the preferred medication for continuous seizures, with a dosage of 0.1 mg/kg IM or 0.2 mg/kg IN, or 0.1 mg/kg IV slow push in 1-2 mg increments, titrated to seizure control.
- Diazepam can be substituted for Midazolam if there is a shortage, with a dosage of 0.1 mg/kg IV/IO or 0.1 mg/kg IM.
- Medication administration is only indicated for continuous seizures in children with a history of non-febrile seizures, respiratory compromise, emesis, or other indications per base hospital order.
Pediatric Seizures
- Hypothermia is a significant problem in pediatric patients.
- Maintain normal temperature during transport to reduce mortality.
- Perform blood glucose determination.
- Administer supplemental oxygen to maintain SpO2 ≥ 94% using the lowest concentration and flow rate possible.
- Apply spinal motion restriction when indicated.
- Protect the patient from further injury.
- Check temperature and begin cooling measures if fever is the cause of the seizure.
Treatment for Continued Seizures
- If blood sugar ≤ 60 mg/dl, treat per PD# 9007 – Pediatric Diabetic Emergencies.
-
Midazolam (IN/IM preferred route):
- IM - 0.1 mg/kg (max dose 4 mg)
- IN 0.2 mg/kg (max dose 6.0 mg)
- IV 0.1 mg/Kg (max dose 4 mg) slow IV push in 1 - 2 mg increments, titrate to seizure control.
-
Diazepam (substitute if Midazolam is unavailable):
- IV/IO - 0.1mg/kg to control seizures
- IM - 0.1mg/kg. May repeat once. Max dose 5 mg.
Considerations
- Many seizures are self-limited and resolve before medication administration.
- Administer Midazolam only for continuous seizing with:
- History of non-febrile seizures, or
- Respiratory compromise, or
- Emesis
- Follow Base Hospital Order for any other indication of seizure activity requiring medication administration.
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Description
This quiz covers essential prehospital interventions for pediatric seizures, including temperature management, blood glucose determination, and oxygen supplementation. Understand the critical steps to ensure safe transport and effective treatment for young patients experiencing seizures.
