Seizures

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Seizures

  1. 1. It makes me want to SHAKE !!!! Assessing & Treating the Seizure Patient Jason N. Cook Captain / Paramedic Layton City Fire Department
  2. 2. Case #1 <ul><li>Midvale/Sandy Call </li></ul>
  3. 3. Case #2 <ul><li>9 yr. old febrile seizure </li></ul>
  4. 4. Incidence <ul><li>Seizure disorders are a common neurological problem. In the United States alone, it has been estimated that more than 4 million people have some form of epilepsy. </li></ul><ul><li>The risk of epilepsy from birth through age 20 is approximately 1 percent. Within this group, the risk is highest during the first year of life and increases somewhat at the onset of puberty. From age 20 to 55 it decreases again, but increases after age 55. </li></ul><ul><li>The prevalence of epilepsy (defined as the total of the population suffering from a disorder at a particular time) has been estimated to be about 5 to 8 in every 1,000 people. </li></ul>
  5. 5. Seizures <ul><li>Seizures (or convulsions ) are temporary abnormal electrophysiologic phenomena of the brain, resulting in abnormal synchronization of electrical neuronal activity. </li></ul><ul><li>They can manifest as an alteration in mental state, tonic or clonic movements and various other symptoms. </li></ul><ul><li>The medical syndrome of recurrent, unprovoked seizures is termed epilepsy . </li></ul>
  6. 6. Seizures <ul><li>Causes of provoked seizures include head trauma, intoxication, infection, metabolic disturbances, withdrawal symptoms (from sedatives such as alcohol, barbiturates and benzodiazepines) and space-occupying processes in the brain (abscesses, tumors). </li></ul><ul><li>Seizures during (or shortly after) pregnancy can be a sign of eclampsia . </li></ul>
  7. 7. Seizures <ul><li>Seizure is often associated with a sudden and involuntary contraction of a group of muscles. Seizures can cause involuntary changes in body movement or function, sensation, awareness, or behavior. </li></ul>
  8. 8. Seizures <ul><li>A seizure can also be as subtle as marching numbness of a part of body, a brief loss of memory, sparkling of flashes, sensing an unpleasant odor, a strange epigastric sensation or a sensation of fear. </li></ul><ul><li>A seizure can last from a few seconds to status epilepticus, a continuous seizure that will not stop without intervention. </li></ul>
  9. 9. Seizures <ul><li>Sometimes seizures may go unnoticed, depending on their presentation, and sometimes seizures may be confused with other events, such as a stroke, which can also cause falls or migraines. </li></ul>
  10. 10. Seizures <ul><li>Persons who have lived with epilepsy for much of their lives may find that their seizures change as they age. The duration of the seizures may become longer or shorter; the intensity of the seizures may worsen or improve; seizure episodes may occur more or less frequently </li></ul>
  11. 11. Important Facts to Remember… <ul><li>Although seizures look different, they have certain things in common: </li></ul><ul><ul><li>During a seizure, a person may stop breathing, generally only for only a few seconds. </li></ul></ul><ul><ul><li>Although some can last as long as 3-5 minutes, most seizures only last 1-2 minutes. </li></ul></ul><ul><ul><li>The brain almost always stops the seizures safely and naturally. </li></ul></ul>
  12. 12. Important Facts to Remember… <ul><ul><li>Unless a seizure persists an excessive duration, once a seizure has begun, you cannot stop it - just let it run its course. </li></ul></ul><ul><ul><li>People don't feel pain during a seizure, although muscles might be sore afterwards. </li></ul></ul><ul><ul><li>Seizures are usually not life threatening, but the risk is increased in seniors by the extra strain on the heart, the possibility of injury, or a reduced intake of oxygen. </li></ul></ul>
  13. 13. Diagnosing Seizures & Epilepsy <ul><li>The doctor usually orders a variety of tests to help make the diagnosis. These include: </li></ul><ul><ul><li>A brain wave test, also called an EEG (electroencephalogram), to look for changes in the brain's electrical patterns that are related to seizures </li></ul></ul><ul><ul><li>Blood tests, to look for certain medical disorders </li></ul></ul><ul><ul><li>Either a special x-ray of the brain, a CT scan (sometimes called a CAT scan), or an MRI scan (magnetic resonance imaging), to look for abnormal areas such as a tumor or infection. </li></ul></ul>
  14. 14. Diagnosing Seizures & Epilepsy <ul><li>Depending on the urgency of the situation, other tests also might be recommended, such as a lumbar puncture (also called a spinal tap), EKG (electrocardiogram, to check the heart), or a sleep test. </li></ul><ul><li>The results of these tests often appear completely normal in people with epilepsy. </li></ul><ul><li>Normal test results do not mean that the seizures are not real or that epilepsy is not present. </li></ul>
  15. 15. Types of Seizures <ul><li>While there are over 40 types of seizure, most are classed within 2 main categories: </li></ul><ul><ul><li>Generalized seizures occur when the excessive electrical activity in the brain encompasses the entire organ. The 2 most common forms are generalized absence seizures and tonic-clonic seizures. </li></ul></ul>
  16. 16. Types of Seizures <ul><li>While there are over 40 types of seizure, most are classed within 2 main categories: </li></ul><ul><ul><li>Partial seizures occur when the excessive electrical activity in the brain is limited to one area. The 2 most common forms are simple partial seizures and complex partial seizures. </li></ul></ul>
  17. 17. Generalized Seizures <ul><li>Primary Generalized Seizures Absence seizures Myoclonic seizures Atonic seizures Tonic seizures Clonic seizures Tonic-clonic seizures </li></ul>
  18. 18. Absence Seizures <ul><li>Absence Seizures (aka petit-mal) typically have a sudden onset, present with motor arrest, sometimes eye blinking, and last a few seconds. </li></ul><ul><li>In an absence seizure, epileptic activity occurs throughout the entire brain. It is a milder type of activity which causes unconsciousness without causing convulsions. After the seizure, there is no memory of it. Usually there is no aura, or warning. </li></ul><ul><li>An absence seizure begins abruptly and without warning, consists of a period of unconsciousness with a blank stare, and ends abruptly. There is no confusion after the seizure, and the person can usually resume full activity immediately. An absence seizure may be accompanied by chewing movements, rapid breathing, or rhythmic blinking. </li></ul>
  19. 19. Absence Seizures <ul><li>Absence seizures are short, usually lasting only 2-10 seconds. They are very mild, and may go unnoticed by parents and teachers. Because absence seizures may recur frequently during the day, a child who experiences them may have difficulty learning if they are not recognized and treated </li></ul><ul><li>Simple absence seizures are just stares. Many absence seizures are considered complex absence seizures, which means that they include a change in muscle activity. The most common movements are eye blinks. Other movements include slight tasting movements of the mouth, hand movements such as rubbing the fingers together, and contraction or relaxation of the muscles. </li></ul>
  20. 20. Myoclonic Seizures <ul><li>They involve abrupt muscle jerks in part or all the body. A hand may suddenly fling out, a shoulder may shrug, a foot may kick, or the entire body may jerk. Myoclonic seizures usually cause abnormal movements on both sides of the body at the same time </li></ul><ul><li>Consciousness and memory are not impaired. A myoclonic seizure may cause a patient to spill or drop what s/he is holding or to fall from his/her chair. </li></ul><ul><li>Even people without epilepsy can experience myoclonus in hiccups or in a sudden jerk that may wake you up as you're just falling asleep. </li></ul>
  21. 21. Atonic Seizures <ul><li>Muscle &quot;tone&quot; is the muscle's normal tension. &quot;Atonic&quot; (a-TON-ik) means &quot;without tone,&quot; so in an atonic seizure, muscles suddenly lose strength. The eyelids may droop, the head may nod, and the person may drop things and often falls to the ground. These seizures are also called &quot;drop attacks&quot; or &quot;drop seizures.&quot; The person may or may not remain conscious. </li></ul><ul><li>Although there is no convulsion, without warning the patient will collapse and fall to the floor and may bang their heads as they fall. Recovery occurs after a few seconds. After regaining consciousness, the patient can again stand and walk. </li></ul>
  22. 22. Tonic Seizures <ul><li>In a &quot;tonic&quot; seizure, the tone is greatly increased and the body, arms, or legs make sudden stiffening movements. Consciousness is usually preserved. </li></ul><ul><li>The more prolonged seizures usually are convulsive and may manifest pupillary dilation, tachycardia, apnea, cyanosis, salivation, and the loss of bladder or bowel control. Tonic seizures are often followed by postictal confusion. </li></ul><ul><li>Tonic seizures most often occur during sleep and usually involve all or most of the brain, affecting both sides of the body. If the person is standing when the seizure starts, he or she often will fall. </li></ul><ul><li>Tonic seizures are very uncommon, especially when they occur without clonic jerking. They usually are manifest with Lennox-Gastaut syndrome or, less commonly, with multiple sclerosis. </li></ul><ul><li>Tonic seizures most often develop in childhood, although they can occur at any age. </li></ul>
  23. 23. Tonic Seizures <ul><li>Tonic seizures are very uncommon, especially when they occur without clonic jerking. They usually are manifest with Lennox-Gastaut syndrome or, less commonly, with multiple sclerosis. </li></ul><ul><li>Tonic seizures most often develop in childhood, although they can occur at any age. </li></ul>
  24. 24. Clonic Seizures <ul><li>&quot;Clonus&quot; (KLOH-nus) means rapidly alternating contraction and relaxation of a muscle -- in other words, repeated jerking. The movements cannot be stopped by restraining or repositioning the arms or legs. Consciousness may be temporarily lost and followed by confusion. </li></ul><ul><li>Clonic (KLON-ik) seizures are rare, however. Much more common are tonic-clonic seizures, in which the jerking is preceded by stiffening (the &quot;tonic&quot; part). </li></ul><ul><li>Sometimes tonic-clonic seizures start with jerking alone. These are called clonic-tonic-clonic seizures! </li></ul>
  25. 25. Tonic-Clonic Seizures <ul><li>This type is what most people think of when they hear the word &quot;seizure.“ </li></ul><ul><li>An older term for them is &quot;grand mal.&quot; </li></ul><ul><li>As implied by the name, they combine the characteristics of tonic seizures and clonic seizures. The tonic phase comes first: All the muscles stiffen. Air being forced past the vocal cords causes a cry or groan. The person loses consciousness and falls to the floor. The tongue or cheek may be bitten, so bloody saliva may come from the mouth. The person may turn a bit blue in the face. </li></ul><ul><li>After the tonic phase comes the clonic phase: The arms and usually the legs begin to jerk rapidly and rhythmically, bending and relaxing at the elbows, hips, and knees. After a few minutes, the jerking slows and stops. Bladder or bowel control sometimes is lost as the body relaxes. Consciousness returns slowly, and the person may be drowsy, confused, agitated, or depressed. </li></ul>
  26. 26. Tonic-Clonic Seizures <ul><li>Drooling, biting of the tongue, and incontinence of urine may occur. </li></ul><ul><li>After a seizure, the person may feel fatigue, confusion and disorientation. This may last from 5 minutes to several hours or even days. Rarely, this disorientation may last up to 2 weeks. The person may fall asleep, or gradually become less confused until full consciousness is regained. </li></ul><ul><li>The patients may experience prolonged weakness after the event; this is termed Todds paralysis. </li></ul>
  27. 27. Partial Seizures <ul><li>Partial Seizures Simple partial seizures Complex partial seizures </li></ul>
  28. 28. <ul><li>Simple partial seizures result from epileptic activity which is localized in one part of the brain, usually the cortex or limbic system. </li></ul><ul><li>Consciousness is not impaired: people experiencing a simple partial seizure can talk and answer questions. They will remember what went on during the seizure. </li></ul><ul><li>Simple partial seizures usually last just a few seconds, although they may be longer. If there are no convulsions, they may not be obvious to the onlooker. </li></ul><ul><li>In some children, simple partial seizures lead to complex partial seizures, or to tonic-clonic convulsions. </li></ul>Simple Partial Seizures (Jacksonian Seizures, Focal Cortical Seizures)
  29. 29. Simple Partial Seizures <ul><li>Simple partial seizures take different forms in different people. They are further classified according to their symptoms: </li></ul><ul><ul><li>Autonomic Seizures - These seizures are accompanied by autonomic symptoms or signs, such as abdominal discomfort or nausea which may rise into the throat (epigastric rising), stomach pain, the rumbling sounds of gas moving in the intestines (borborygmi), belching, flatulence and vomiting. This has sometimes been referred to as abdominal epilepsy . Other symptoms may include pallor, flushing, sweating, hair standing on end (piloerection), dilation of the pupils, alterations in heart rate and respiration, and urination. A few people may experience sexual arousal, penile erection, and orgasm. </li></ul></ul>
  30. 30. Simple Partial Seizures <ul><ul><li>Emotional and Other - Simple partial seizures which arise in or near the temporal lobes often take the form of an odd experience. One may see or hear things that are not there. One feels emotions, often fear, but sometimes sadness, anger, or joy. There may be a bad smell or a bad taste, a funny feeling in the pit of the stomach or a choking sensation. These seizures are sometimes called simple partial seizures of temporal lobe origin or temporal lobe auras . </li></ul></ul>
  31. 31. Simple Partial Seizures <ul><ul><li>Motor - Other simple partial seizures include (clonic, jerking) convulsive movements. Jerking typically begins in one area of the body -- the face, arm, leg, or trunk -- and may spread to other parts of the body. These seizures are sometimes called Jacksonian motor seizures ; their spread is called a Jacksonian march . It cannot be stopped. </li></ul></ul><ul><ul><li>Sensory Seizures - Some simple partial seizures consist of a sensory experience. The person may see lights, hear a buzzing sound, or feel tingling or numbness in a part of the body. These seizures are sometimes called Jacksonian sensory seizures . </li></ul></ul>
  32. 32. Simple Partial Seizures <ul><li>When motor symptoms spread slowly from one part of the body to another, this &quot;epileptic march&quot; has been termed jacksonian epilepsy (first described by Hughlings Jackson). </li></ul>
  33. 33. Complex Partial Seizures (Psychomotor/Temporal Lobe Seizures) <ul><li>A complex partial seizure occurs when epileptic activity spreads to both temporal lobes in the brain. A complex partial seizure often occurs after a simple partial seizure of temporal lobe origin. </li></ul><ul><li>A complex partial seizure does not involve convulsions, but consciousness is impaired. Someone experiencing one will no longer respond to questions after the seizure starts. </li></ul><ul><li>A complex partial seizure often begins with a blank look or empty stare. They will appear unaware of their surroundings and may seem dazed. The seizure may progress to include chewing movements, uncoordinated activity, or sometimes performing meaningless bits of behaviour which appear random and clumsy. </li></ul><ul><li>These automatisms may include actions such as picking at their clothes, trying to remove them, walking about aimlessly, picking up things, or mumbling. </li></ul>
  34. 34. <ul><li>Often accompanying these symptoms are the presence of unusual thoughts, such as the feeling of deja vu (having been someplace before), uncontrollable laughing, fear, visual hallucinations, and experiencing unusual unpleasant odors. These interesting symptoms are thought to be caused by abnormal discharges in the temporal lobe. </li></ul><ul><li>Someone experiencing a complex partial seizure may become frightened and try to run and struggle. </li></ul><ul><li>Following the seizure, there will be no memory of it. </li></ul><ul><li>A complex partial seizure usually lasts about 2 to 4 minutes. It may be followed by a state of confusion lasting longer. </li></ul><ul><li>Complex partial seizures sometimes resist anticonvulsant medication. </li></ul>Complex Partial Seizures (Psychomotor/Temporal Lobe Seizures)
  35. 35. Complex Partial Seizure <ul><li>Some people can have seizures of this kind without realizing that anything has happened. Because the seizure can wipe out memories of events just before or after it, however, memory lapses can be a problem. </li></ul><ul><li>Complex partial seizures starting in the frontal lobe tend to be shorter than the ones from the temporal lobe. The seizures that start in the frontal lobe are also more likely to include automatisms like bicycling movements of the legs or pelvic thrusting. </li></ul>
  36. 36. Psychogenic Seizures (Pseudo-Seizures) <ul><li>Psychogenic seizures are not classified as an epilepsy. </li></ul><ul><li>People of all ages may experience psychogenic seizures. </li></ul><ul><li>They occur 3 times more frequently in women than men. </li></ul><ul><li>They may arise from various psychological factors, may be prompted by stress, and may occur in response to suggestion. </li></ul><ul><li>It has also been found that such disorders may be self-induced. They may be used to get attention, to be excused from work, to collect financial compensation, or merely to escape an intolerable social situation. They seldom occur in the absence of others. </li></ul><ul><li>Psychogenic seizures can be characterized by features common with epilepsy like writhing and thrashing movements, quivering, screaming or talking sounds, and falling to the floor. </li></ul><ul><li>Psychogenic attacks differ from epileptic seizures in that out-of-phase movements of the upper and lower extremities, pelvic thrusting, and side-to-side head movements are evident. </li></ul>
  37. 37. Psychogenic Seizures (Pseudo-Seizures) <ul><li>Psychogenic seizures may last a couple of minutes or hours, ending as abruptly as they began. </li></ul><ul><li>Anxiety may be experienced prior to an attack, followed by relief and relaxation afterwards, leading some to postulate that psychogenic seizures may occur as a direct response to stress in order to relieve tension. </li></ul><ul><li>Afterwards, patients usually have a vague recollection of the seizure, without the usual post ictal symptoms of drowsiness and depression. </li></ul><ul><li>It is difficult to differentiate between psychogenic and epileptic seizures. Statistics indicate that, in 20-30% of cases, epileptologists are incorrect in attempting to distinguish one from the other. </li></ul><ul><li>Medications are ineffective in the treatment of psychogenic disorders. Patients are usually referred to a therapist, to learn to control stress and become familiar with coping techniques. Since the vast majority of psychogenic seizures operate on a psychological level, behavioral manipulation methods may be used. </li></ul>
  38. 38. Febrile Seizures <ul><li>Febrile seizure occurs when a child has a high fever, most commonly above 38.3°C (101°F), and usually on the first day of a rapid rise in body temperature. </li></ul><ul><li>A febrile seizure is usually seen in children between 6 months and 3 years of age, although they can occur in children to 10 years of age. Febrile seizures will be experienced by only 3-4% of children and only with a fever </li></ul><ul><li>There are 2 types of febrile seizures: simple and complex. </li></ul><ul><ul><li>Simple febrile seizures are more common and relatively harmless. They usually last less than 15 minutes and have no after-effects. A neurological examination following a simple seizure will yield no abnormalities. </li></ul></ul><ul><ul><li>Complex febrile seizures may be more threatening: they can occur at body temperatures lower than 38.3°C and can last longer than 15 minutes. Only 1 side of the body is affected during a complex febrile seizure and neurological reports may indicate abnormalities . </li></ul></ul>
  39. 39. Febrile Seizures <ul><li>There are a number of possible causes of febrile seizures. Children have a higher susceptibility to seizure activity in the brain -- a lower seizure threshhold -- because of their age and the immaturity of their body's immune system. Complicated by a rapidly rising fever and possibly the general condition of health, a febrile seizure may occur. </li></ul><ul><li>Several other factors may increase the risk of seizure: a family history of seizures, chronic maternal ill health, parental fertility problems, breech birth, Caesarean birth, small birth weight, developmental delay, and cerebral problems may increase the incidence of febrile seizures. Smoking and drug intake (including anti-epileptic drugs) during pregnancy can further increase the risk. </li></ul>
  40. 40. Febrile Seizures <ul><li>A febrile seizure produces no lasting effects. Only 25-30% of children who experience one will ever have another. </li></ul><ul><li>Febrile seizures are rare; recurrence even rarer. </li></ul>
  41. 41. Status Epilepticus <ul><li>Status epilepticus is prolonged, repetitive seizure activity that lasts more than 20 to 30 minutes, during time which the patient is unconscious. </li></ul><ul><li>A patient is also considered to be in “status” if he/she experiences multiple seizures without becoming lucid between seizures. </li></ul><ul><li>Status epilepticus is a medical emergency with a significantly poor outcome; it can result in death if not treated aggressively. </li></ul><ul><li>Its causes include improper use of certain medications, stroke, infection, trauma, cardiac arrest, drug overdose, and brain tumor. </li></ul>
  42. 42. Atypical Seizures <ul><li>Catamenial Seizures </li></ul><ul><li>Catamenial refers to seizure activity associated with a woman's menstrual cycle. </li></ul><ul><li>Studies have shown that fluctuations in female hormones prior to and during menstruation may elevate seizure frequency in some women. </li></ul><ul><li>In a small percentage of women, catamenial seizures may occur only during the days just before their periods; for others, during the period itself. </li></ul><ul><li>Higher ratios of estrogen to progesterone may increase seizure frequency. Water retention, electrolyte imbalance, and even poor sleep are also contributing causes. </li></ul>
  43. 43. Non-traditional Therapies <ul><li>Diet </li></ul><ul><ul><li>Ketogenic Diet – Specialized high fat, low carbohydrate diet </li></ul></ul><ul><ul><li>Modified Atkins Diet – Less restrictive than Ketogenic Diet. </li></ul></ul><ul><li>Surgery </li></ul><ul><ul><li>Dramatically increased in 80’s & 90’s </li></ul></ul><ul><ul><li>Studies suggest the earlier the surgery, the better the outcome. </li></ul></ul><ul><ul><li>Often done after only 1-2 yrs. of trying multiple medications. </li></ul></ul><ul><ul><li>Especially effective in those with associated structural brain abnormalities, such as benign brain tumors, malformations of blood vessels (including disorders known as arteriovenous malformations, venous angiomas, and cavernous angiomas), and strokes. </li></ul></ul>
  44. 44. Non-traditional Therapies <ul><li>Vagus Nerve Stimulating Devices </li></ul><ul><ul><li>The VNS device is sometimes referred to as a &quot;pacemaker for the brain.&quot; It is placed under the skin on the chest wall and a wire runs from it to the vagus nerve in the neck and is often activated with a magnet worn as a watch. </li></ul></ul><ul><ul><li>Patients who suffer from complex partial seizures or generalized seizures where consciousness is lost, and who do not respond to anticonvulsant medication, and patients who cannot undergo brain surgery are considered good candidates for vagus nerve stimulation therapy. It also may be ecommended as a treatment for photosensitive epilepsy and epilepsy resulting from head injury </li></ul></ul>
  45. 45. Assessment & History <ul><li>When obtaining history, remember to include the following: </li></ul><ul><ul><li>History of seizures, including length of seizures, auras, generalized or focal, </li></ul></ul><ul><ul><li>History of head trauma. </li></ul></ul><ul><ul><li>Alcohol/drug use </li></ul></ul><ul><ul><li>Recent history of fever, headache, or stiff neck. </li></ul></ul><ul><ul><li>History of diabetes, heart disease, stroke. </li></ul></ul><ul><ul><li>Medications, including compliance </li></ul></ul>
  46. 46. Assessment & History <ul><ul><li>Description of seizure activity </li></ul></ul><ul><ul><ul><li>Duration </li></ul></ul></ul><ul><ul><ul><li>Typical/Atypical pattern of seizure activity for patient. </li></ul></ul></ul><ul><ul><ul><li>Post ictal phase </li></ul></ul></ul><ul><ul><ul><li>Incontinence </li></ul></ul></ul><ul><ul><ul><li>Tongue biting </li></ul></ul></ul>
  47. 47. Common Anticonvulsant Medications <ul><li>Carbamazepine </li></ul><ul><li>Carbatrol </li></ul><ul><li>Clobazam </li></ul><ul><li>Clonazepam </li></ul><ul><li>Depakene </li></ul><ul><li>Depakote </li></ul><ul><li>Depakote ER </li></ul><ul><li>Diastat </li></ul><ul><li>Dilantin </li></ul><ul><li>Felbatol </li></ul><ul><li>Frisium </li></ul><ul><li>Gabapentin </li></ul><ul><li>Gabitril </li></ul><ul><li>Keppra </li></ul><ul><li>Klonopin </li></ul><ul><li>Lamictal </li></ul><ul><li>Lyrica </li></ul><ul><li>Mysoline </li></ul><ul><li>Neurontin </li></ul><ul><li>Phenobarbital </li></ul><ul><li>Phenytek </li></ul><ul><li>Phenytoin </li></ul><ul><li>Sabril </li></ul><ul><li>Tegretol </li></ul><ul><li>Tegretol XR </li></ul><ul><li>Topamax </li></ul><ul><li>Trileptal </li></ul><ul><li>Valproic Acid </li></ul><ul><li>Zarontin </li></ul><ul><li>Zonegran </li></ul><ul><li>Zonisamide </li></ul>
  48. 48. Resistance to Medications <ul><li>Approximately </li></ul><ul><ul><li>50% of seizures are eliminated by medication, </li></ul></ul><ul><ul><li>30% of seizures are reduced in intensity and frequency by medication, </li></ul></ul><ul><ul><li>20% of seizures are resistant to medication. </li></ul></ul>
  49. 49. Prehospital Treatment <ul><li>Assess / Address Inadequate ABC’s </li></ul><ul><ul><li>Provide ventilatory support </li></ul></ul><ul><li>Determine Level of Consciousness. </li></ul><ul><li>Protect patient from additional harm. Consider C-spine precautions. </li></ul><ul><li>Apply O 2 via Nasal Cannula. Obtain O2 Sats. </li></ul><ul><li>Determine blood sugar level. </li></ul><ul><ul><li>Administer D 50 W in the hypoglycemic patient </li></ul></ul><ul><li>Determine patient temperature. </li></ul><ul><li>Establish IV access / Obtain blood tubes. </li></ul><ul><li>In actively seizing patient administer anticonvulsants </li></ul><ul><ul><li>Midazolam (Versed) </li></ul></ul><ul><ul><li>Diazepam (Valium) </li></ul></ul><ul><ul><li>Observe for respiratory depression . </li></ul></ul><ul><li>Transport </li></ul>
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