Describe the Various Ways a Seizure Can Present
Common cause = epilepsy - chronic brain disorder characterized by recurrent seizures
1. tonic-clonic seizure (aka grand mal seizure): the seizing phase will last only a few minutes; might not be seizing when you arrive on scene.
-After the patient stops s
Pathophysiology of Seizures/Kinds of Seizures
-Seizures can either be categorized as:
1. Primary Seizures: in adults this is usually caused by a genetic or unknown cause
1a. Generalized Primary Seizures: involves both hemispheres of the brain and the reticular activating system, which typically resul
Status Epilepticus
-A patient who suffers from generalized motor seizures that last more than 5 minutes or seizures that occur consecutively without a period of responsiveness between them
-dire concern: airway management, positive pressure ventilation with oxygen and immed
Explain the Concerns Associated With Prolonged or Successive Seizures
-The longer the delay of treatment, the greater the risk of the patient suffering from permanent brain damage
Generalized Tonic-Clonic (Grand Mal) Seizure
-abnormal electrical activity low in the cerebral cortex that spreads upward, affecting both hemispheres, and spreads downward, affecting the reticular activating system
RAS: responsible for sleep/wake activity
-involvement of both hemispheres contributes
Six Stages of a Generalized Tonic-Clonic Seizure (pg 548-549) and Emergency Care
1. Aura: serves as a warning that a seizure is going to happen. Some sort of sensory perception (like a sound, twitch, anxiety, dizziness, unpleasant feeling in the stomach, etc).
-generalized seizures do commonly occur without an aura
2. Loss of Consciou
Simple Partial Seizure and Emergency Care
-aka focal motor seizure or jacksonian motor seizure
-involves one cerebral hemisphere
-for this reason, it typically produces jerky muscle activity in one area of the body, arm, leg, or face
-patient is awake and aware that this is happening because no d
Complex Partial Seizure and Emergency Care (550)
-aka psychomotor or temporal lobe seizure
-usually lasts 1 to 2 minutes because it only involves one hemisphere
-patient will remain awake but not aware of their surroundings
-blanks stare, followed by random activity like chewing, lip smacking, or rollin
Absence (Petit Mal) Seizure
-most common in children
-blank stare, beginning and ending abruptly and lasting only a few seconds
-rapid blinking, chewing, and lack of attention ->
EMERGENCY CARE: not needed, unless this is a first time observation, then med evaluation is recommended
Febrile Seizure
-caused by high fever
-most common in children ages 6 months and 6 years
5% of children that have high fever will have this
-secondary/reactive seizures
-very short and may not require emergency care
-always assume they do need it though, because you won'
Assessment Based Approach to Seizure Activity
SCENE SIZE UP:
-look for mechanism of injury like blunt or penetrating trauma; check environment for poisoning
-patient may no longer be seizing when you get there, so he may be in a postictal state; once responsive, may refuse transport (like if he's in
Assessing the Postictal Patient
-if they're talking without distress, it indicates open airway and breathing
-heart rate is commonly elevated and skin is warm and moist
-if seizure was self limited and typical, emergency care may not be needed.
Assessing Patients Who Are Unresponsive to Verbal or Painful Stimuli, Actively Seizing, or in Status Epilepticus
-open airway with a jaw-thrust or head tilt chin lift
-may need npa
-during seizing, large amounts of saliva are produced during seizing and tongue is commonly bitten, so suction
-don't insert an opa
-chest wall muscles contract and restrict effective bre
Transport Priority Circumstances in Seizing
-when the patient remains unresponsive following the seizure
-abc's is inadequate following the seizure
-a second generalized motor seizure occurs without a period of responsiveness between the seizure episodes (aka status epilepticus)
-a generalized moto
Relevant Questions to Ask While Gathering a History of the Seizure *
(p 553)
*
-Was the patient awake during the seizure?
-Was muscle activity a twitching or jerking motion?
-When did the seizure start?
-How long did it last (remember that bystanders tend to overestimate)
-Did the patient experience an aura before the seizure?
Many
Discuss the Role of Blood Glucose Determination in Patients Who Had a Seizure
-hyperglycemia may trigger a seizure
-if blood glucose is less than 60mg/dl, seizure is due to a low blood glucose level
Signs and Symptoms of A Seizure
-These are general signs and symptoms that may indicate a seizing activity:
1. Convulsions
2. Rigid muscular contraction or muscle spasm
3. Bitten tongue
4. Excessive Saliva
5. Urinary or bladder incontinence
6. Chewing movement, smacking lips, wringing h
Emergency Care for Seizures (554)
1. Position the patient
2. Maintain open airway
3. Suction
4. Assist ventilation
5. Prevent injury to the patient
6. Maintain adequate oxygenation
7. Transport
Common Causes for Syncope (Fainting) (556)
-occurs when there's a temporary lack of blood flow to the brain and the brain is deprived of oxygen for a brief period
1. Common cause of syncope is an overwhelming influence of the PNS that causes blood vessels to dilate throughout the body
-When patien
Differences between a syncope and seizure event (556)
With syncope:
1. Episode usually begins in a standing position
2. Patient remembers feeling faint or light-headed
3. Patient becomes responsive almost immediately after becoming supine
4. Skin is usually pale and moist