What is the first-line management for an actively seizing child in the ED?

• A. Delay treatment until seizures stop
• B. Administer a benzodiazepine promptly; ensure airway and monitor vitals; prepare for additional therapy if needed.
• C. Use only oral meds
• D. Try cooling measures first

Answer: (B)

When a child is actively seizing in the emergency department, the immediate goal is rapid seizure control while keeping the airway open and the child’s breathing and circulation stable. A benzodiazepine acts fastest to stop seizures by boosting inhibitory signaling in the brain, so giving it promptly is the most effective first move. Use whichever route is quickest and most reliable in the moment—IV if available, otherwise intranasal or buccal forms, with rectal options as needed.

At the same time, ensure airway protection, provide oxygen if indicated, and continuously monitor vital signs. Have difficult airway equipment ready and be prepared to escalate therapy if the seizure continues or recurs. This approach minimizes brain injury risk from prolonged seizures and sets the stage for subsequent treatments or investigations to address the underlying cause. Avoid delaying anticonvulsant therapy or relying on oral meds while the seizure is ongoing, and remember that cooling measures aren’t first-line unless fever-related issues are part of the scenario.