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

 

Actively Seizing?

 

• Yes

 

IV Established?

 

• Yes

 

• • Midazolam (Versed) 2.5 - 5mg IV/IO may repeat  ONCE
    • • • OR
  • Lorazepam (Ativan) 2 mg IV/IO may repeat ONCE

 

Actively Seizing?

 

• No

 

• • Midazolam (Versed) 10 mg IM; may repeat once
  • Initiate IV/IO

 

Still Seizing ?

 

• Yes

 

• • Contact Medical Control

 

 

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