- How long has it been going? (Start the clock.)
- Is there IV access? Any epilepsy history or rescue plan?
Do now
- Go now — ask them to call for help and start timing
- Protect from injury; recovery position; oxygen; suction
- Check glucose
- Benzodiazepine at 5 min
- Senior / anaesthetics if still seizing
Key doses
- Lorazepam 0.1 mg/kg IV (usually 4 mg)
- No IV: buccal midazolam 10 mg or rectal diazepam 10–20 mg
- Repeat once after 5–10 min
- Second line: levetiracetam 60 mg/kg IV (max 4.5 g)
Typical adult doses — always check the BNF and your local guideline.
Call your senior if
- Seizing > 5 min or recurrent without recovery
- Second benzodiazepine needed
- First seizure, head injury, or not waking up
Think of
- Epilepsy / missed medication
- Hypoglycaemia
- Alcohol withdrawal
- Hyponatraemia
- Intracranial cause
- Eclampsia if pregnant
Go deeper
The full walkthroughs behind this call.