Seizures | Neurological Emergencies

Seizure: sudden abnormal brain cell activity. Seizures reoccurring over a span of years is called epilepsy. 3/4ths of people with epilepsy have their first seizures before age 20.

Four types of seizures:
Generalized major motor seizures: tonic-clonic, muscles rapidly contract and relax. Also called Grand mal, last 2-5 minutes
Focal motor seizures or simple partial seizures. 1-2 minutes or may spread to body and become generalized.
Behavioral Seizure: brief absence, could be temporal lobe epilepsy, also called complex-partial seizure, or in children called petit mal seizure
Status Epilepticus: series of seizures without a period of wakefulness between them.

Secondary Causes of Seizures: they are not a disease, they are a symptom.
Infection (meningitis, brain abscess, encephalitis)
Failure to take anti-seizure meds
Metabolic abnormalities
Drug overdose or alcohol i.e. TCAs
Hypertensive emergency
Liver or kidney failure

Patient Assessment: F A C T S
Focus, focal motor or generalized body involvement
Activity; what movements took place
Color, did they turn cyanotic
Time, how long did it last
Secondary info like OPQRST for pain, get a SAMPLE history

Postictal state: decreased LOC lasting about 30 minutes. Watch for violent behavior.

Give hi flow O2
Don’t put anything in their mouth
Assist ventilation as nec.
Be prepared for suction
Do not restrain, use padding to protect them
Start an IV line
Cardiac monitor
Check O2 sats
Transport in recovery position
Anti-seizure Drugs: diazepam (Valium), lorazepam (Ativan) Follow your local guidelines. 

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