Save a Life with Rectal Diazepam

1. Save a Life with Rectal Diazepam Rachel Gallagher, RN, CPNP, NCSN DPI School Nurse Consultant (608) 266-8857 Rachel.gallagher@dpi.wi.gov

2. Prevalence 1.5 million Americans – active epilepsy 325,000 children (up to age 14) have active epilepsy (EPA, 2006) 300,000 per year – newly recognized seizure

3. Data 90% of seizures last less than 2 minutes The longer the seizure, increases the likelihood of long term complications and mortality 42,000 people die every year due to status epilepticus $3.8 to $7 billion per year in inpatient cost

4. Goal of Seizure Management The time of seizure onset to initial treatment is critical in attaining seizure control and timely administration of effective seizure treatment is essential to preventing neuronal damage and permanent cerebral injury (Bleck, 1999). Prompt treatment prevents status epilepticus and decreases mortality or death(Pellock, 2004)

5. Definition Acute Repetitive Seizures (ARS) Child with a history of recurrent seizure activity with periodical episode of repetitive seizure activity. Characteristics: Severe Predictable, consistent in presentation Historically distinct from other seizure activity Onset and progression is recognizable Patient may recover between seizure Constellation of activity – recurrent, serial, cluster, crescendo seizures

6. Definition Status Epilepticus (SE) Continuous seizure activity or intermittent seizure activity lasting 30 minutes or more with a return to consciousness (Bleck, 2002). Seizure activity lasting 5-10 minutes (Lowenstein, 1999; DeLorenzo, 1999) 126,000 to 195,000 estimated cases per year of Status Epilepticus; 42, 000 deaths each year in U.S. Time to treatment (5-10 minutes) dictates outcome of SE emergencies The seizure get more refractory to treatment the longer the activity goes on.The seizure get more refractory to treatment the longer the activity goes on.

7.  What is needed prior to administration of rectal diazepam? Medical provider authorization or order Parent authorization or order Verification of correct dosage – Window Green ready band Training – Knowledge – Medication On-Line Training and webcast Return demonstration of physical skill

8. When do I give the rectal diazepam? Medical provider and parent authorization Length of time of seizure activity

9. What do I need to have available to give rectal diazepam? Watch Gloves Prefilled syringe with rectal diazepam gel Lubricant Blanket and other materials to maintain privacy

10. Procedure 1. Time seizure and determine need to administer medication. 2. Have another adult call 911. 3. Confidentially remove clothing from buttock and drape. 4. Push up on cap with thumbs to remove cap. 5. Lubricate the tip by inserting it into lubricant. 6. Move the student to side-lying position, facing you with upper leg forward exposing rectum. 7. Separate the buttock to expose the rectum.

11. Procedure continued 8. Insert the syringe gently into the rectum until the rim is snug against the rectal opening. 9. Push the plunger in slowly counting to three until the plunger stops. 10. With syringe still in rectum count to three. 11. Remove syringe and immediately hold buttock together and count to three again, to prevent leakage of medication.

12. Procedure Continued 12. Monitor seizure and respiratory effort. 13. Begin CPR as needed. 14. Notify school nurse and parent. 15. Keep student on their side. 16. Note time. 17. If not already done, call 911.

13. Demonstration “The three threes”

14. Practice

15. Questions regarding administration of rectal diazepam in your school district can be directed to your school nurse or administrator. Questions regarding this training webcast can be directed to: Rachel Gallagher, RN, CPNP, NCSN DPI School Nurse Consultant (608) 266-8857 Rachel.gallagher@dpi.wi.gov