Given that when a child is having a seizure, it can be a stressful situation, it is highly recommended that you familiarize yourself with that child’s seizure emergency care plan before hand
Considerations:
- Given that the medication can be dispensed in different formats and dosages, the school nurse should always review the medication and order upon receiving it at the school
- Given that when a child is having a seizure, it can be a stressful situation, it is highly recommended that you familiarize yourself with that child’s seizure emergency care plan beforehand
- Store the seizure emergency plan in a location that is easily accessible during a seizure
- Be sure to check expiration date on the medication bottle
- Lorazepam expires 90 days after it has been opened and requires refrigeration
- Midazolam can be stored at room temperature and there is no specific expiration date once the medication has been opened
- Secured, but accessible storage of the medication should be considered in your medication administration plan
- Be sure to ensure the child’s privacy and confidentiality when calling for assistance. Do not say the child’s name over the PA system or walkie-talkie
- If possible, have someone assist with removing onlookers and other students to provide the child with privacy
- NOTE: The Food and Drug Administration (FDA) has not approved lorazepam or midazolam for administration via this medication route. Since healthcare providers are currently prescribing the medications via this route, if you have questions or concerns, discuss this with the prescribing healthcare provider or the pharmacist
Supplies:
- Seizure emergency action plan
- Documentation log
- Medication
- Syringe or dropper
- Gloves
- Gauze or paper towel
First aid for a seizure:
- Call for assistance if someone else is present.
- Place the child on a flat surface such as the floor being sure not to move the child any more than is necessary
- Turn the child onto his/her side to allow vomit/phlegm to be expelled rather than inhaled
- Place something soft under the child’s head to protect them from injury
- Ensure the child’s airway is not obstructed
- Loosen tight clothing around the child’s neck
- Do not restrict the child’s arms or legs
- Ensure there is no furniture or objects close to the child that could injure him/her
- Review the child’s emergency care plan
- Gather the emergency medication and needed supplies in case seizure lasts longer than designated time frame
Procedure:
- If possible, wash your hands
- Assemble the needed supplies
- Put on gloves
- Check the bottle of medication to ensure that it is:
- For the right child
- The right medication
- The right dose
- Being given at the right time
- Being given by the right route, and
- Not expired
- Ensure the appropriate amount of time has passed prior to administering the student’s seizure medication.
- If there is another adult present, have them call 911/EMS as you administer the medication.
- Open the bottle of medication
- Place the syringe or dropper into the bottle of medication until the end of the syringe/dropper is in the fluid
- Draw up the correct dose of medication, ensuring that the dose is correct once the syringe or dropper is removed
- If the dose is incorrect the fluid can be squirted back into the bottle and withdrawn again
- Retract the child’s lower lip and slowly squirt the drug into the mouth between the lip and gum
- Squirt half of the medication into one side of their mouth and the remaining medication into the other side of the mouth
- Administer the medication slowly, taking care not to spill the drug outside the oral cavity
- Take care not to squirt the medication onto the tongue or into the open throat of the child
- Do not place the syringe or dropper between their teeth as they may bite it
- There is no need to open the child’s jaw as the medicine does not need to be swallowed
- After squirting the medication into the gum remove the syringe/dropper but keep the lip retracted for a few seconds
- Use gauze swabs to wipe their mouth after
- Remove gloves
- If EMS/911 has not been called yet, call 911 or EMS services
- Stay with the child, monitoring breathing
- If breathing stops, begin rescue breaths
- If breathing and heartbeat stop, begin CPR
- Once rescue squad arrives, inform them of medication administered, including type of medication, dose and time
- Remember to dispose of all used equipment and bottles of medicine safely out of the reach of children
- Wash hands
- Document the date, time and dose of medication given in addition to what was observed during the seizure
- Follow up with the parent or guardian and healthcare provider, as needed.
References:
Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures. Chapter 64: Medication Administration: Nasal (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Holsti, M., Sill, B.L., Firth, S.D., Filloux, F.M., Joyce, S.M., Furnival, R.A. (2007). Prehospital IN Midazolam for the Treatment of Pediatric Seizures. Pediatric Emergency Care, 23(3).
Ice Epilepsy Alliance. (2014). Emergency Administration of Rescue Medications. Available at: http://www.ice-epilepsy.org/emergency-administration-of-rescue-medications.html
Therapeutic Intranasal Drug Delivery. Available at: http://intranasal.net/Treatmentprotocols/default.htm
Wolfe, T.A., Braude, D.A. (2010). Intranasal Medication Delivery for Children: A Brief Review and Update. Pediatrics, 126, 532-37.
Wolfe, T.A., Macfarlane, T.C. (2006). Intranasal Midazolam Therapy for Pediatric Status Epilepticus. American Journal of Emergency Medicine, 24, 343–46.
Acknowledgment of Reviewers:
The procedure list and video for this procedure were developed in collaboration with the Wisconsin Department of Public Instruction.
Freddi Adelson, MS, RN
School Nurse Consultant
Wisconsin Department of Public Instruction
Bette Carr, MSN, RN, NCSN
School Health Associates
Co-Owner/Consultant
Kari Caldwell Stampfli, RN, MS, CPNP, APNP, CHPPN
Pediatric Nurse Practitioner/Clinical Nurse Specialist
Hematology/Oncology/Bone Marrow Transplant/Neurosciences/Palliative Care
American Family Children’s Hospital
Page last reviewed: October 5, 2021
Page last updated: October 5, 2021
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