Buccal Midazolam

Hello, my name is Gemma Farrand, and I'm one of the Special Needs School Nurses for Cambridgeshire Community Services. This presentation will demonstrate how to effectively give Buccal Midazolam. You should have already done the online theory behind this before watching this demonstration. A seizure, also known as a fit or convulsion, is an episode of abnormal electrical activity in the brain.

Bucal means that the medicine is administered into the mouth and is absorbed through the lining of the mouth. Midazolam is a sedative medicine that controls and reduces electrical activity in the brain. Thereby helping to stop a seizure. Buccal Midazolam is given when a child has a long seizure, generally more than five minutes. But every child is different, so it's important to have the child seizure care plan in front of you.

Buccal Midazolam comes in two forms: Buccolam, which is the prefilled syringes in varying doses, depending on the child's age and Epistatus, which is the liquid preparation in a 5mm bottle, which comes with 4 syringes. So, for the prefilled syringes, the first thing to do is, it's important to check the expiry date, and it's correctly labelled for that child, then remove the syringe from the packaging. It should be sealed. Remove the red tape on the end, and this should automatically remove the clear part inside. It's really important this happens because it can be a choking hazard. Gently pull down the bottom lip and place the syringe into the bottom of the child's mouth between the lower gum and the cheek. Do not place between the teeth as the child could bite down on the syringe. Slowly administer the medication until the syringe is empty. If possible split the dose in half so that it's given in each side of the child's mouth. This medication is not meant to be swallowed, but absorbed into the bloodstream by the Buccal cavity for quick absorption, which is why it's so important to administer slowly confirm the seizure has stopped and monitor for any breathing problems. Keep the syringe in case you need to show a health professional what you have given.

So, Epistatus, check the expiry date and discard if you can see any crystals. Unscrew the bottle, keeping it upright. Insert the syringe and turn the bottle upside down and bring some of the medication into the syringe. Push it back into the bottle to get rid of any air bubbles and then slowly pull a syringe back until you get that child's dose. Gently pull down the bottom lip and insert the syringe into the bottom of the child's mouth between the lower gum and the cheek. Do not place in between the teeth as the child could bite down on the syringe. Slowly administer the medication until the syringe is empty and again, if possible, split the dose into halves, so it is given into each side of the child's mouth. This medication is not meant to be swallowed, but absorbed into the bloodstream via the Buccal cavity for quick absorption, which is why it’s important for it to be administered slowly. Again, confirm the seizure has stopped and monitor for any breathing problems.

Dispose of the syringe afterwards. Make a note of what time you gave the Buccal Midazolam and then follow the child seizure plan as to what the next steps are for that child. Call an ambulance if: the seizure does not stop within ten minutes of it starting; you cannot administer Buccal Midazolam or can't give the full dose; or if the child's breathing slows down or stops.

Thank you for watching this demonstration. If you have any questions, please contact us, we'll be happy to help.