Epilepsy

Key signs:

Sudden loss of consciousness, patient may become rigid, fall, might give a cry and becomes cyanosed (tonic phase)
Jerking movements of the limbs; the tongue might be bitten (clonic phase)

N.B. Fitting might be associated with other conditions (e.g. hypoglycaemia, fainting)

Symptoms include:

Brief warning or ‘aura’
Frothing from the mouth and urinary incontinence

Management

Assess the patient.
Do not try to restrain convulsive movements.
Ensure the patient is not at risk from injury.
Secure the patient’s airway.

Administer 100% oxygen

Flow rate: 15 litres/minute.

As for adults

For adults:

Administer 100% oxygen

Flow rate: 15 litres/minute.

For children:

As for adults

The seizure will typically last a few minutes; the patient might then become floppy but remain unconscious. Once the patient regains consciousness they may remain confused.

However, if the epileptic fit is repeated or prolonged (5 minutes or longer), continue administering oxygen and:

Administer 10 mg midazolam (use 2 ml oromucosal solution, 5 mg/ml) topically into the buccal cavity.^§

Midazolam oromucosal solution (5 mg/ml)^ǂ
6-11 months	2.5 mg
1–4 years	5 mg
5–9 years	7.5 mg
10–17 years	10 mg

For adults:

Administer 10 mg midazolam (use 2 ml oromucosal solution, 5 mg/ml) topically into the buccal cavity.^§

For children:

Midazolam oromucosal solution (5 mg/ml)^ǂ
6-11 months	2.5 mg
1–4 years	5 mg
5–9 years	7.5 mg
10–17 years	10 mg

After convulsive movements have subsided, place the patient in the recovery position and check the airway. Do not send the patient home until they have recovered fully.
Only give medication if convulsive seizures are prolonged (last for 5 minutes or longer) or recur in quick succession. In these cases and if this was the first episode of epilepsy for the patient, the convulsion was atypical, injury occurred or there is difficulty monitoring the patient, call for an ambulance.