Protect patient from injury
If possible, place patient in left lateral position to reduce risk of aspiration
Do not place bite block!
Jaw thrust, a NPA and oxygen may be required
An IV line should be placed
If possible, place patient in left lateral position to reduce risk of aspiration
Do not place bite block!
Benzodiazepine (Initial treatment of choice)
Midazolam IM 10 mg (> 40 kg), 5mg (13-40 kg), or 0.2 mg/kg
May also be given IN at 0.2 mg/kg, max 10 mg
OR buccal at 0.3 mg/kg, max 10 mg
Lorazepam IV 4 mg or 0.1 mg/kg; may repeat one dose
Diazepam IV 0.15-0.2 mg/kg (up to 10 mg); may repeat one dose or PR 0.2-0.5 mg/kg (up to 20 mg) once 
Secondary medications
ESETT trial compared second line antiseizure medications and they all are equally efficacious. Therefore may be best to use the one with least side effects  which is Levetiracetam
Levetiracetam IV 60 mg/kg, max 4500 mg/dose, or 1500 mg oral load  (preferred in pregnancy)
Phenytoin IV 18 mg/kg at ≤ 50 mg/min  (avoid in pregnancy)
Fosphenytoin IV 20-30 mg/kg at 150 mg/min (may also be given IM)
Contraindicated in pts w/ 2nd or 3rd degree AV block
Avoid phenytoin or fosphenytoin in suspected toxicology case due to sodium channel blockade
Valproic acid IV 20-40 mg/kg at 5 mg/kg/min, max 3000 mg  (avoid in pregnancy)
Refractory medications
Propofol 2-5mg/kg, then infusion of 2-10mg/kg/hr OR
Midazolam 0.2mg/kg, then infusion of 0.05-2mg/kg/hr OR
Ketamine  loading dose 0.5 to 3 mg/kg, followed by infusion of 0.3 to 4 mg/kg/hr
Lacosamide IV 400 mg IV loading dose over 15 min, then maintenance dose of 200 mg q12hrs PO/IV
Phenobarbital IV 15-20 mg/kg at 50-75 mg/min
Then continuous infusion at 0.5-4.0 mg/kg/hr
Dose adjusted to suppression-burst pattern on continuous EEG
Consider consulting anesthesia for inhaled anesthetics (potent anticonvulsants)
Others
Carbamazepine 8 mg/kg oral suspension, single oral load
Gabapentin 900 mg/day oral at 300 mg tid for 3 days
Lamotrigine 6.5 mg/kg single oral load
Midazolam IM 10 mg (> 40 kg), 5mg (13-40 kg), or 0.2 mg/kg
May also be given IN at 0.2 mg/kg, max 10 mg
OR buccal at 0.3 mg/kg, max 10 mg
Lorazepam IV 4 mg or 0.1 mg/kg; may repeat one dose
Diazepam IV 0.15-0.2 mg/kg (up to 10 mg); may repeat one dose or PR 0.2-0.5 mg/kg (up to 20 mg) once 
May also be given IN at 0.2 mg/kg, max 10 mg
OR buccal at 0.3 mg/kg, max 10 mg
ESETT trial compared second line antiseizure medications and they all are equally efficacious. Therefore may be best to use the one with least side effects  which is Levetiracetam
Levetiracetam IV 60 mg/kg, max 4500 mg/dose, or 1500 mg oral load  (preferred in pregnancy)
Phenytoin IV 18 mg/kg at ≤ 50 mg/min  (avoid in pregnancy)
Fosphenytoin IV 20-30 mg/kg at 150 mg/min (may also be given IM)
Contraindicated in pts w/ 2nd or 3rd degree AV block
Avoid phenytoin or fosphenytoin in suspected toxicology case due to sodium channel blockade
Valproic acid IV 20-40 mg/kg at 5 mg/kg/min, max 3000 mg  (avoid in pregnancy)
Contraindicated in pts w/ 2nd or 3rd degree AV block
Avoid phenytoin or fosphenytoin in suspected toxicology case due to sodium channel blockade
Propofol 2-5mg/kg, then infusion of 2-10mg/kg/hr OR
Midazolam 0.2mg/kg, then infusion of 0.05-2mg/kg/hr OR
Ketamine  loading dose 0.5 to 3 mg/kg, followed by infusion of 0.3 to 4 mg/kg/hr
Lacosamide IV 400 mg IV loading dose over 15 min, then maintenance dose of 200 mg q12hrs PO/IV
Phenobarbital IV 15-20 mg/kg at 50-75 mg/min
Then continuous infusion at 0.5-4.0 mg/kg/hr
Dose adjusted to suppression-burst pattern on continuous EEG
Consider consulting anesthesia for inhaled anesthetics (potent anticonvulsants)
Then continuous infusion at 0.5-4.0 mg/kg/hr
Dose adjusted to suppression-burst pattern on continuous EEG
Carbamazepine 8 mg/kg oral suspension, single oral load
Gabapentin 900 mg/day oral at 300 mg tid for 3 days
Lamotrigine 6.5 mg/kg single oral load
Secondary causes of seizure (e.g. hyponatremia, hypoglycemia, INH toxicity, ecclampsia)
Nonconvulsive seizures or<unk>  - get EEG
Status epilepticus
Epileptic seizure
Myxedema coma
First-time seizure
Febrile seizure
Seizure with known seizure disorder
Excited delirium
Alcohol withdrawal seizures