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Status Epilepticus — RACP Paediatrics MCQ

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ModerateNeurology & DevelopmentStatus EpilepticusRACP Paediatrics

A child has been seizing for 10 minutes on arrival to the emergency department. IV access has been obtained. Two doses of buccal midazolam (0.3 mg/kg) were given pre-hospital (total at 0 and 5 minutes). The seizure continues. According to RCH Melbourne guidelines, what is the next step?

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Correct answer: C — IV midazolam 0.15 mg/kg

RCH Melbourne seizure management algorithm: first-line is benzodiazepines (buccal midazolam 0.3 mg/kg or IV midazolam 0.15 mg/kg). After 2 doses of benzodiazepines pre-hospital, the next step upon gaining IV access is IV midazolam 0.15 mg/kg. If the seizure persists after 2 total IV benzodiazepine doses, second-line agents (phenytoin or levetiracetam) are indicated.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Seizures Acute Management