Continuous Tonic-Clonic Seizures (Adult)

Assess
• Protect Pt • Continuously monitor airway and ventilation - assist as required • Consider other causes e.g. Hypoglycaemia • Consider Pt’s own management plan and treatment already given
Continuous Tonic-Clonic Seizure
Ensure accurate dosage - 1/2 dose for age >60 yr
Age >60 - Midazolam 0.05mg/kg IM
Age <60 - Midazolam 0.1mg/kg IM (max. single dose 10mg)

			MICA IV Access?
						No
				Yes
Seizure activity ceases BLS Monitor airway and BP			Seizure activity continues >5 minutes Midazolam 0.05mg/kg IV - Repeat Midazolam 0.05mg/kg IV, 2 to 5 minutely as required Consult for further doses Consider Intubation Pancuronium contraindicated			Seizure activity continues >10 minutes QAP or No IV access (MICA) Repeat original Midazolam IM dose once only Consult for further doses Monitor airway and BP

Max combined Midazolam IM and IV dose = 2.5mg/kg, which is: >60 Years old: 5 x 0.5mg/kg IM and IV Doses <60 years old: 1 x 1mg/kg IM and 3 x 0.5mg/kg IM / IV doses

Special Notes

If single seizure which has spontaneously terminated continue with initial management and transport.

For seizures other than generalised tonic-clonic seizures, Midazolam may only be administered following medical consultation.

Seizures may not always present with tonic-clonic limb activity, e.g. unconsciousness with flicking eye movements (nystagmus) may indicate ongoing seizure activity.

If Pt has a past history of seizures, and refuses transport, leave them in the care of a responsible third person. Advise the person of the actions to take for immediate continuing care if symptoms reoccur, and the importance of early contact with their primary care physician for follow-up.

Frequent errors in drug dosage administration occur within AV in this Guideline.

Ensure accurate dose calculation and confirm with other Paramedics on scene.

Midazolam can have pronounced effects on BP, conscious state and airway tone.

Calculate the dose each time as stock strength may change with manufacturer and familiarity may lead to errors.