Anne Dobbs Lead ACP Emergency Medicine Seizure Anne Dobbs Lead ACP Emergency Medicine

Objectives Discuss the management of a patient with seizure Understand management of patient post seizure Referral criteria for seizure

Case Study You are called because a 35 Male is found to be having a seizure in the treatment room On your arrival he is actively having a generalised seizure He has a past medical history of Epilepsy, T1DM and learning difficulties

Causes of seizures Epilepsy Stroke Meningitis Encephalitis Cerebral malaria Brain tumor Brain abscess SOL Acute head injury Hypoxic ischemic brain injury Advanced Alzheimer / dementia Hypertensive encephalopathy Arteriovenous malformation Cerebral vasculitis Poisoning Alcohol withdrawal Hepatic / renal failure Hypo / Hyper glycaemia Electrolyte disturbance Proconvulsive drugs

Patient Assessment

Seizure management Airway Management Oxygen Consider suction BM (If available other blood tests including anticonvulsant levels) Diazepam 10 mg PR / IV repeated after 10 mins if required Midazolam 10mg buccal Lorazepam 2-4mg IV When seizure stops repeat ABCDE assessment If seizure does not stop 999

Red Flags Onset > 30 years Persistent focal neurology Recent history head / neck trauma Seizure in immunosuppressed patient Seizure with known drug use or alcohol dependency Seizures in patients with cancer diagnosis Seizures following new medication initiation Seizure in clinically unwell patient Pregnancy Crescendo seizures Status eplilepticus

Referral If emergency 999 If patient stable but requires further investigation or management refer to medicine / neurology If patient stable and no ongoing signs consider referral to first fit clinic Give advice to patient to avoid driving / swimming / heights until further investigation

Hypoglycaemia <3mmol/L ExPLAIN Exogenous drugs Pituitary insufficiency Liver failure Addisions disease Islet cell tumour Non-pancreatic neoplasms Glucagon 1mg IM / IV 200-300ml 10% dextrose Food / Drink

Any Questions