The patient’s circulatory status must also be closely monitored Seizures generally cause a massive sympathetic discharge that result in hypertension and tachycardia Continuous monitoring and intravenous (IV) access should be obtained Blood samples, including rapid blood glucose and sodium testing, should be acquired at this time Hypoglycemia should be corrected urgently, yet mild stress hyperglycemia during seizure episode usually does not require treatment Peripheral IV access, which is often difficult in the pediatric age group, may be nearly impossible in the actively seizing patient Intraosseous and/or central venous access may be required in the patient with prolonged seizures Once the respiratory and circulatory functions have been assessed and maintained, efforts should be directed at stopping any ongoing seizure activity and making a diagnosis As long as adequate ventilation and oxygenation are maintained, long-term sequelae are unlikely to result from a transient seizure Consensus management suggests the initiation of anticonvulsant treatment of anyone who has been seizing for more than minutes This likely represents all patients who are brought to the ED actively seizing EVALUATION AND DECISION History As a result of the numerous potential causes of seizures, as well as the large number of events that can be mistaken for a seizure, a focused history is important The parent or caregiver needs to carefully describe the episode and the preceding events Was there a warning (aura) that the patient was about to have an event? Was there a loss of consciousness, tongue biting, or incontinence? Did the event involve the entire body or only a portion? How long did the event last? How did the patient act after the event was over? The clinician should take into account that the event characteristics may not be accurately perceived by a distressed parent With smartphones and digital media being more common, parents may present a video clip of the event to the treating clinician, especially for recurring events In addition to the episode itself, the preceding events are also crucial Was there a history of trauma, toxin exposure or ingestion, fever, or other systemic signs of illness (e.g., headache, ataxia, vomiting, diarrhea)? Does the child have an underlying seizure disorder, history of seizures, or other neurologic problems? Is the child taking any anticonvulsants? If yes, was there a recent change in dose, or were any medications started or stopped? Is there a chance that the patient could have a subtherapeutic level, especially if there were any recently missed doses?