Synopsis
Recognise and terminate prolonged seizures promptly, protect airway and dignity, identify reversible precipitants in line with goals, provide reliable non-oral rescue and maintenance routes, and prevent recurrent medication and supply failure.
- Time every event and describe onset, awareness, movement, eye and head deviation, colour, injury, duration and recovery; video can help with consent.
- First-line seizure aid is safety: cushion the head, remove hazards, do not restrain limbs or put anything in the mouth, and use recovery position afterward.
- Treat a convulsive seizure at 5 minutes with the prescribed rescue route and call emergency help according to the individual plan.
Key red flags
A first seizure, focal onset, new weakness, severe headache, trauma or anticoagulation requires urgent intracranial assessment when treatment is appropriate.
Convulsion lasting 5 minutes or recurrent seizures without recovery requires immediate benzodiazepine and escalation.
Investigation priorities
Document trigger, focal onset, awareness, movements, colour, injury, timed duration, rescue response and postictal recovery.
Management branches
A convulsive seizure reaches 5 minutes or recurs without recovery.
- Call emergency help, protect airway and patient, give oxygen as indicated, check glucose and administer authorised buccal, rectal or intravenous benzodiazepine without delay.
- Time and record the dose, repeat only under the current status protocol and prepare airway support because cumulative benzodiazepine and opioid can depress ventilation.
Key medicines
Buccal midazolam for adult prolonged seizureGive 10 mg into the buccal cavity once when an adult convulsive seizure reaches the individual plan threshold, commonly 5 minutes; call emergency help and repeat only when the prescribed local protocol explicitly authorises it.
Intravenous lorazepam for status epilepticusGive 4 mg intravenously over 2 minutes in monitored adult convulsive status, repeating once after 5 to 10 minutes if seizure persists according to the current hospital protocol before second-line escalation.