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Management of tonic-clonic seizure lasting more than 5 minutes

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

In addition to the measures taken in the acute management of tonic-clonic seizures, patients who have prolonged (lasting 5 minutes or more) or repeated (three or more in an hour) convulsive seizures should be treated with:

  • buccal midazolam - as first-line treatment
  • rectal diazepam - if preferred or if buccal midazolam is not available (1)

Notes:

  • Acutely, during a tonic-clonic seizure:
    • there should be clear space around the patient
    • place some support under the person’s head and neck (a cushion a folded coat or support the head with another person hand)
    • loosen any tight neckwear, belts etc. and also remove any spectacles
    • place the patient in the recovery position and aid general recovery once the seizure has taken its course; wipe away any excess mucus and check their airways and breathing. Ensure that the patient cannot hurt themselves
    • seizure duration should be timed
    • bystanders should not
      • move the patient except in circumstances where he or she is in danger of further injury e.g. from fire or traffic
      • place anything in the mouth or give anything by mouth
      • restrict the movement of the patient or lift the patient (2)
    • emergency treatment should be sought in cases where
      • a single seizure persists for longer than 5 minutes or 2 minutes longer than what is normal for that person
      • the person does not regain consciousness
      • there are multiple seizures (three or more seizures in an hour)
      • an injury has occurred to the person
      • the person may have inhaled water
      • breathing difficulties continue
      • it’s the persons first seizure (2,3)

Reference:

 

 

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