What is an appropriate treatment for seizures in the field?

• A. Intranasal midazolam
• B. Rectal diazepam
• C. Intravenous phenytoin
• D. Oral lorazepam

Answer: (A)

In the field, stopping a seizure quickly with a fast, noninvasive treatment is essential. Administering a benzodiazepine via the nasal route provides rapid onset of action by absorbing through the nasal mucosa, so you can treat a child who is actively seizing without needing IV access or rectal administration. This approach overlays two practical advantages: it works fast and it’s easy to give in a prehospital setting, often right at the patient’s side while you monitor airway and breathing.

Intranasal midazolam works by enhancing GABA activity in the brain, which dampens neuronal excitability and halts ongoing seizure activity. The weight-based dosing is designed to achieve effective drug levels quickly while minimizing prolonged sedation. It’s well established as a first-line option for acute seizure termination in children because it delivers rapid relief with a relatively favorable safety profile when used with appropriate monitoring.

Rectal diazepam can be used when intranasal options aren’t available, but its use is less convenient and absorption can be variable, which may delay seizure control. Intravenous phenytoin is not for immediate termination; it has a slower onset for stopping seizures and carries risks associated with IV anticonvulsants. Oral lorazepam is not suitable during an active seizure in the field because it requires swallowing and has slower, unpredictable absorption in an acutely convulsing patient, plus a higher risk of aspiration.

Thus, intranasal midazolam is the best choice for promptly stopping seizures in a prehospital pediatric setting.