1. Save a Life with Rectal Diazepam – Diastat®

2.  Make sure the volume is turned up (volume button beneath the speaker’s picture)  Make sure the volume on the computer is turned up (volume icon located on the right hand side of your computer taskbar)  Contact your IT department  If audio and visual is lost during the program, go back to: http://media2.wi.gov/dpi/catalog/, and click on the Student Services Prevention and Wellness Team link on the left, then when the SSPW Team page of archived programs appears, select the program link desired. http://media2.wi.gov/dpi/catalog/  If problem persists contact Rachel Gallagher (608) 266-8857.

3. This power point, web cast and competency test will satisfy the knowledge portion of medication training. To complete the medication training for this emergency medication, school personnel will need to have a their medication administration skill verified and documented by a school nurse, medical provider or adequately training parent by performing an independent demonstration of the skill. Competency checklist are available at: http://dpi.wi.gov/sspw/schlnurse.html

4.  What is a seizure, status epileptus, and acute repetitive seizures?  What is the prevalence of epilepsy?  What are the goals of seizure management?

5.  What are the school responsibilities for management of students with epilepsy?  What are the steps in the administration of rectal diazepam - Diastat®?  What are the side effects of rectal diazapem - Diastat®?

6.  An abnormality resulting in a sudden episode of uncontrolled electrical activity in the brain. If the abnormal activity remains confined to one area, the person may experience tingling or twitching of only a small area of the body, such as the face or an extremity. If the electrical activity spreads throughout the brain, consciousness is lost and a tonic clonic or generalized seizure results. Recurrent seizures are called epilepsy.  Causes of seizures may be many neurological or medical problems including head injury, infection, stroke, brain tumor, metabolic or alcohol.

7.  Continuous seizure activity  Seizure activity lasting 5-10 minutes (Lowenstein, 1999; DeLorenzo, 1999)  Time to treatment (5-10 minutes) dictates outcome of SE emergencies  Intermittent seizure activity lasting 30 minutes or more with a return to consciousness (Bleck, 2002).

8.  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

9.  90% of seizures last less than 2 minutes  The longer the seizure, increases the likelihood of long term complications and mortality  126,000 to 195,000 estimated cases per year of status epilepticus; 42,000 death each year in U.S.

10.  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).

11.  Identification of students with epilepsy.  Develop school policy and procedure for epilepsy management.  Emergency and Individual Health Care Plan  Training of staff on first aide, medications, and emergency action plan.  Minimize impact to the student’s education.  Obtain medical provider and parent authorization.  Verification of dosage.

14.  Right Student  Right Medication  Right Dosage  Right Time  Right Route

15. 1. Time seizure and determine need to administer medication. 2. Have another adult call 911. 3. Apply gloves 4. Confidentially remove clothing from buttock and drape. 5. Push up on cap with thumbs to remove cap. 6. Lubricate the tip by inserting it into water soluble lubricant.

16. 7. Move the student to side-lying position, facing you with upper leg forward exposing rectum. 8. Separate the buttock to expose the rectum. 9. Insert the syringe gently into the rectum until the rim is snug against the rectal opening. 10. Push the plunger in slowly counting to three until the plunger stops. 11. With syringe still in rectum administer the medication by depressing plunger over the count of three.

17. 12. Remove syringe and immediately hold buttock together and count to three again, to prevent leakage of medication. 13. Note time. 14. Monitor seizure and respiratory effort. 15. Begin CPR as needed. 16. Notify school nurse and parent. 17. Keep student on their side. 18. If not already done, call 911. 19. Remove gloves, wash hands and secure supplies.

18. Demonstration “The three threes”

19.  COMMON side effects of Diastat® : decreased coordination; diarrhea; dizziness; drowsiness; headache; nervousness; stomach pain; stuffy nose.  SEVERE side effects can occur when using Diastat® : severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); anxiety; hallucinations; mental or mood changes; muscle spasms or twitching; new or worsened seizures; overexcitement; low blood pressure, shortness of breath; sleep disturbances; trouble sleeping; wheezing. Closely monitor students receiving Diastat®

20.  Every dose of medication needs to be documented with the date, time and initials of the person administering the medication on the medication log.

21.  School Nurse  Medical Provider  Parent

22. Any comments regarding this webcast? Any suggestions on future school nursing topics? Contact: Rachel Gallagher (608) 266-8857 E-mail: rachel.gallagher@dpi.wi.gov

23. Take test. Upon completion, take test to nurse or administrator for scoring.