Traditionally, status epilepticus was defined as 30 minutes of continuous seizure activity or a series of seizures without return to full consciousness between the seizures.   Many believe that a shorter period of seizure activity causes neuronal injury and that seizure self-termination is unlikely after 5 minutes.  Some suggest times as brief as 4-5 minutes to define status epilepticus.  Although the first priority is airway and breathing, additional treatment includes drug therapy to terminate the seizure.  Rectal administration of Diazepam offers an alternative to IV/IO/IM routes in patients who often present with difficult vascular access.

 

Status Epilepticus

            Continuous seizure for > 5 minutes

 

 

 

Lubrication, water soluble

Tuberculin syringe (without needle) or angiocath with 3 to 5 ml syringe

Diazepam, injectible solution

Tape (Optional)

 

 

1)      Use the pediatric tape to determine the weight if the child or establish the patient’s weight from information provided by the caregiver.

 

2)      The rectal dose of diazepam is 0.5 mg/kg, or five times the IV dose, to a maximum dose of 10 mg.  Onset of action is slower than IV diazepam.

 

3)      Draw up the calculated dose of diazepam into a disposable tuberculin syringe or 3 –5 ml syringe.

 

4)      Lubricate the syringe or catheter:

 

                                                               i.      If using the tuberculin syringe as the administration device, remove needle and apply lubricant to the tip of the syringe.

 

                                                             ii.      If using a 3 – 5 ml syringe, remove needle, attach plastic catheter and lubricate catheter.

 

5)      Position the patient in the knee chest position, or supine position with a second pre-hospital provider or the caregiver holding the legs apart.

 

6)      Carefully introduce the syringe or the catheter approximately 5 cm (2 inches) into the rectum.

 

7)      Inject the solution into the rectum.  Remove syringe.

 

8)      Hold buttocks closed for 10 seconds.