Paediatric Seizures; Roadside to Resus

Pediatric seizures represent a significant clinical challenge, accounting for 1-2% of emergency department attendances and requiring a structured approach to prevent secondary brain injury. The pathophysiology involves a critical imbalance between excitatory glutamate and inhibitory GABA neurotransmission, which shifts as seizures prolong, necessitating timely pharmacological intervention. Benzodiazepines remain the first-line treatment, though their efficacy wanes as GABA receptors internalize over time. Second-line agents like levetiracetam offer logistical advantages, while ketamine shows promise in refractory cases by antagonizing NMDA receptors. Effective management hinges on rapid assessment, accurate identification of underlying causes—such as fever, metabolic disturbances, or trauma—and adherence to established protocols for conveyance and escalation. Clinicians must balance the urgency of seizure termination with the need for diagnostic clarity, ensuring that parental reassurance and appropriate safety netting accompany every clinical decision.