During a seizure lasting longer than 5 minutes with no recovery, what should you do?

• A. Remove onlookers
• B. Tongue blade between teeth
• C. Give sugar
• D. Administer midazolam buccally and call 999

Answer: (D)

In a seizure that lasts more than five minutes with no recovery, the situation is a medical emergency (status epilepticus) and requires rapid control of the seizure plus urgent medical help. Administering midazolam by the buccal route provides fast absorption through the cheek, allowing quick stopping or reduction of seizure activity without needing IV access, which is often difficult during a convulsion. At the same time, calling emergency services (999) ensures professional airway management, monitoring, and further treatment if the seizure continues or complications arise.

Avoid putting a tongue blade between the teeth or attempting to restrain the jaw—that can cause injury and aspiration. Giving sugar is not appropriate during an ongoing seizure, especially if the patient is unconscious or unable to swallow safely.

After the seizure ends, place the patient in a safe recovery position, monitor breathing, and await EMS arrival. Having clear protocols to use rescue medication like midazolam and to call for help is essential in this scenario.