Seizure rescue medications provide acute treatment outside of a hospital setting to halt a prolonged seizure or a cluster of seizures. These fast-acting treatments are designed to prevent status epilepticus, a potentially harmful condition involving extended seizure activity. Caregivers or trained individuals administer these medications following a specific, pre-determined protocol developed by the patient’s physician. This individualized plan instructs exactly when and how to give the medication to minimize complications from an extended seizure.
Establishing the Time Threshold for Intervention
Most seizures are brief, typically ending on their own within one to three minutes, and do not require emergency medication. When a convulsive seizure continues without stopping, it enters a dangerous phase known as status epilepticus, defined as five or more minutes of continuous seizure activity or a series of seizures without the person recovering consciousness between them. Rapid intervention is necessary because prolonged seizures can lead to adverse outcomes, including brain injury, due to the high metabolic demands of continuous activity.
The standard medical guideline for initiating treatment is often set at the five-minute mark of continuous seizure activity. This threshold is commonly used because the likelihood of a seizure stopping on its own decreases significantly after this point. The exact trigger for administration, however, is not a universal rule but is determined by the patient’s physician and detailed in their written seizure action plan.
This individualized plan may specify a shorter or longer time frame based on the person’s seizure history, the type of seizure, and their specific medical profile. Tracking the seizure duration accurately from the moment it begins is a fundamental step in the decision-making process for administering the rescue medication. Timely administration is directly correlated with the medication’s effectiveness in terminating the seizure.
Understanding Rescue Medication Formulations
The active ingredients in seizure rescue medications are typically fast-acting benzodiazepines, such as diazepam and midazolam, which work by calming the brain’s overactivity. These medications are formulated for non-oral delivery to ensure they can be administered safely and quickly during an active seizure when a person cannot swallow. The most common routes for out-of-hospital use include nasal spray, buccal (cheek) film, and rectal gel.
These alternative routes bypass the digestive system, allowing the medication to be absorbed directly into the bloodstream through the mucous membranes for a faster onset of action. Intranasal sprays deliver the drug through the nasal lining, while buccal formulations are absorbed through the cheek lining. Rectal gel was the first FDA-approved rescue option for community use and remains an option, especially for younger children.
Preparation involves ensuring the medication is readily accessible and properly stored, usually meaning keeping it at room temperature and away from direct heat. Caregivers must regularly check the expiration date and replace the medication before it expires. The rescue medication should be kept in its original packaging until the moment of use to maintain its integrity.
Step-by-Step Administration Guide
Once the time threshold specified in the patient’s action plan has been reached, the administration process must be executed calmly and efficiently. The first step involves ensuring the patient is in a safe position, typically lying on their side in the recovery position, which helps maintain an open airway and prevents aspiration. Caregivers should never attempt to restrain the patient or place anything in their mouth.
For nasal spray devices, the medication is contained in a single-dose, pre-filled applicator that must not be tested or primed before use, as this will result in a lost dose. The caregiver holds the device securely with their thumb on the plunger and gently inserts the tip of the nozzle into one nostril until their fingers rest against the bottom of the nose. The plunger is then pressed firmly and quickly in one smooth motion to deliver the entire dose.
If the prescribed dose requires two sprays, a second device must be administered into the opposite nostril, following the same technique. For buccal administration, the medication is placed between the cheek and the lower gum, where it is quickly absorbed by the blood vessels in the cheek lining. The goal is to ensure the complete prescribed dose is delivered through the designated route as quickly as possible to maximize the chance of seizure termination.
Monitoring and When to Call Emergency Services
After the rescue medication has been administered, the caregiver must immediately begin close monitoring and track the time of administration. The seizure should generally stop within a few minutes of the medication taking effect. The patient must be continuously observed for signs of respiratory distress, as benzodiazepines can cause sedation and affect breathing.
Emergency medical services (EMS) must be contacted immediately if the seizure does not stop within the time frame specified in the patient’s individual protocol, often 5 to 10 minutes after the rescue medication was given. Other criteria for an immediate emergency call include difficulty with breathing or failure to wake up after the seizure has ended. The person should remain in the recovery position until they are fully alert and aware of their surroundings.
An EMS call is also warranted if the person experiences another seizure soon after the first one without fully regaining consciousness, or if the seizure occurs in water. Any significant injury sustained during the event also requires immediate medical attention.