For a pediatric patient experiencing a febrile seizure lasting more than 5 minutes, what is the recommended prehospital management?

• A. Administer a benzodiazepine per protocol (e.g., intranasal midazolam or IV/IN/rectal diazepam) and ensure airway and oxygen.
• B. Administer acetaminophen only and observe.
• C. Perform rapid cooling only.
• D. Call for immediate transport with no medications.

Answer: (A)

During a febrile seizure that lasts more than five minutes, the priority is to rapidly stop the seizure with a fast-acting benzodiazepine and to protect the airway and provide oxygen. Benzodiazepines given by protocol, such as intranasal midazolam or diazepam by IV, IN, or rectal route, act quickly to reduce neuronal excitability and abort ongoing seizure activity. Administering the medication promptly, while maintaining airway support and oxygen, gives the child the best chance to recover quickly and safely.

After the seizure is halted, continue to monitor the child, manage fever with appropriate care, and arrange for transport for further evaluation. Acetaminophen alone does not stop a seizure, rapid cooling is not sufficient as a sole treatment for an active seizure, and delaying medication in favor of transport with no anticonvulsant therapy can allow prolonged seizure activity to continue.