Status epilepticus – pre-hospital — RACP Paediatrics MCQ

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EasyNeurologyStatus epilepticus – pre-hospitalRACP Paediatrics

A 3-year-old is actively seizing (generalised tonic-clonic) for 6 minutes in the emergency department. IV access has not been established. What is the most appropriate first-line treatment?

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Correct answer: E — Buccal midazolam

Per the RCH Melbourne Seizures Acute Management CPG and ANZCOR guidelines, when IV access is not available, buccal midazolam (or IM midazolam) is the first-line treatment for convulsive status epilepticus. Rectal diazepam is an alternative but buccal midazolam is preferred for ease of administration.

Reference: RCH Melbourne – 2024 – Seizures Acute Management CPG; ANZCOR – 2024 – Paediatric ALS