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
- 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 before hand
- 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
- 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
- The medication can be very irritating to the nasal membranes and create a burning sensation, additional adult assistance may be required to administer the medication
- 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
- Seizure emergency action plan
- Documentation log
- Prescribed medication
- Bulb syringe
- Sharps container
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
- If possible, wash your hands
- Assemble the needed supplies
- Put on gloves
- Check the vial 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 that the proper amount of time has passed prior to administering the student’s seizure medication
- If there is another adult present, have them call EMS/911 as you administer the medication
- Twist or place the needle onto the syringe
- Remove the cap from the vial of medication
- Insert the needle into the vial and withdraw prescribed amount of medication
- Pull the needle and syringe out of the vial and verify the dose of the medication
- Twist off or remove the syringe from the needle
- Attach the atomizer tip to the syringe and twist into place
- Discard the needle in a sharps container
- Look into the child’s nostrils to determine if there is fluid or mucous in the nostrils.
- If drainage or mucous is present, use a bulb syringe to remove it
- Using your free hand to hold the crown of the head stable, place the tip of the atomizer snugly against the nostril aiming slightly up and outward
- Quickly compress the syringe plunger to deliver half of the medication into the nostril
- Move the device over to the opposite nostril and administer the remaining medication into that nostril
- The child may grimace or appear more restless momentarily after the medication is given
- 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 on the documentation log
- Follow up with the parent or guardian and healthcare provider, as needed
Ahmed, R. (2007). Low-dose buccal midazolam for aborting seizures in children. Journal of Pediatric Neurology, 5(4),291-93
Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures. Chapter 64: Medication Administration: Nasal (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Butler, S.M., Boucher, E.A., Tobison, J., & Phan, H. (2020). Medication use in schools: Current trends, challenges, and best practices. J Pediatr Pharmacol Ther., 25(1): 7–24. doi: 10.5863/1551-6776-25.1.7
Hartman, A.L., Devore, C.D.L, American Academy of Pediatrics and the Section on Neurology, et al. (2016). Rescue medicine for epilepsy in education settings. Pediatrics, 137(1):e20153876. Retrieved April 8, 2020, from https://pediatrics.aappublications.org/content/137/1/e20153876.
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).
Lagae, L. (2011). Clinical practice: The treatment of acute convulsive seizures in children. Eur J Pediatr, Apr;170(4):413-8. doi: 10.1007/s00431-011-1403-z. Epub 2011 Feb 8.
Ice Epilepsy Alliance. (2014). Emergency Administration of Rescue Medications. Available at: http://www.ice-epilepsy.org/emergency-administration-of-rescue-medications.html
National Association of School Nurses. (2018). School nursing evidence-based clinical practice guideline: Students with seizures and epilepsy. Retrieved April 8, 2020, from https://www.pathlms.com/nasn/courses/8992
Schachter, S.C., Shafer, P.O., Sirven, J.I., and Epilepsy Foundation. (2013). Oral rescue medications 101. Retrieved April 14, 2020, from https://www.epilepsy.com/learn/managing-your-epilepsy/using-rescue-treatments/oral-rescue-medicines-101. Retrieved April 14, 2020
Therapeutic Intranasal Drug Delivery. Available at: http://intranasal.net/Treatmentprotocols/default.htm
University of Wisconsin Hospitals and Clinics Authority. (2013). Health facts for you. Treatment of prolonged seizures and prevention of status epilepticus with buccal lorazepam or midazolam. Retrieved April 22, 2020, from https://www.uwhealth.org/healthfacts/neuro/7212.html.
Wilfong, A. (2020). Management of convulsive status epilepticus in children. In a D.R. Nordli, Jr. (Ed.), UpToDate. Retrieved: April 8, 2020.
Wilfong, A. (2020). Seizures and epilepsy in children: Refractory seizures and prognosis. In a D.R. Nordli, Jr. (Ed.), UpToDate. Retrieved: April 8, 2020.
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 Initial 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
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
Procedure last reviewed: October 5, 2021
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