In absence of IV access, what's the most effective method to treat the most common childhood neurologic emergency?

The most common childhood neurologic emergency is status epilepticus. Options for treatment in absence of IV access include rectal diazepam and buccal midazolam, with buccal midazolam demonstrating greater efficacy (in terms of more rapid termination of seizure activity and no increased incidence of respiratory depression) relative to rectal diazepam in a study by McIntyre et al.

Buccal administration of midazolam uses the IV formulation injected into the space between the gum and cheek. Click here to see an illustrative diagram of the procedure.

Source

McIntyre J MD, et al. "Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomized controlled trial." Lancet 2005 Jul 12: 205-10.

Wilfong, A MD. "Treatment fo seizures and epileptic syndromes in children." Up to Date. 27 May 2008.