Seizures

 

History:

 

  • Reported/witnessed seizure activity
  • Previous seizure history
  • Medical alert tag information
  • Seizure medications
  • History of trauma
  • History of diabetes
  • History of pregnancy

 

Significant Findings:

 

  • Decreased mental status
  • Sleepiness
  • Incontinence
  • Observed seizure activity
  • Evidence of trauma
  • Unconscious

 

Differential:

 

  • CNS (head) trauma/stroke
  • Tumor
  • Metabolic, hepatic, or renal failure
  • Hypoxia
  • Electrolyte abnormality (Na, Ca, Mg)
  • Drugs/medications
  • Non-compliance
  • Infection/fever
  • Alcohol withdrawal
  • Eclampsia
  • Hyperthermia
  • Hypoglycemia

 

 

Treatment:

 

    • Oxygen
    • Consider 12-Lead EKG
    • Obtain BGL

 

Still Seizing ?

 

  • Yes

 

 

  • No

 

    • Follow Appropriate Guideline

 

 

PEARLS:

 

  • Status epilepticus is defined as two or more successive seizures without a period of consciousness or recovery. This is a true emergency requiring rapid airway control, treatment, and transport.
  • Grand mal seizures (generalized) are associated with loss of consciousness, incontinence, and tongue trauma.
  • Focal seizures (petit mal) effect only a part of the body and are not usually associated with a loss of consciousness.
  • Jacksonian seizures are seizures which start as a focal seizure and become generalized.
  • Be prepared for airway problems and continued seizures.
  • Assess possibility of occult trauma and substance abuse.
  • Be prepared to assist ventilations especially if Midazolam (Versed) or Diazepam (Valium) is used.
  • For any seizure in a pregnant patient, follow the Eclampsia/Pre-eclampsia Protocol.
  • Consider Lorazepam (Ativan) IV push if hypotensive
  • The maximum dose without Medical Control for Lorazepam (Ativan) is 4 mg and Midazolam (Versed) is 12.5 mg. DO NOT exceed maximum