Drill of the Month Developed by Gloria Bizjak Altered Mental Status: Assessing and Managing Seizure Patients

Drill of the Month2 Altered Mental Status: Assessing and Managing Seizure Patients Student Performance Objective: Given information, resources, and opportunity for discussion and practice, EMTs will be able to: List causes, types, and signs and symptoms of List causes, types, and signs and symptoms of seizures, seizures, Describe patient care procedures, and Describe patient care procedures, and Demonstrate patient assessment and care. Demonstrate patient assessment and care. EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers.

Drill of the Month3 Altered Mental Status: Assessing and Managing Seizure Patients Overview Causes of Seizures Causes of Seizures Types of Seizures and Their Signs and Symptoms Types of Seizures and Their Signs and Symptoms Patient Care Procedures Patient Care Procedures

Drill of the Month4 Causes of Seizures By age group By age group –6 months to 3 years  Common: high fever (febrile seizures)  Metabolic abnormalities –High/low sugar or sodium levels –Low calcium or magnesium levels –Vitamin B 6 deficiency Once the abnormality is resolved the seizure will not cease. Reoccurrence is likely from a birth injury/defect, hereditary metabolic abnormality, or brain disorder Once the abnormality is resolved the seizure will not cease. Reoccurrence is likely from a birth injury/defect, hereditary metabolic abnormality, or brain disorder

Drill of the Month5 Causes of Seizures By age group By age group –Age 2 to 14 years  Often the cause is unknown  May be the result of measles, mumps, other childhood diseases

Drill of the Month6 Causes of Seizures By age group By age group –After age 25  Head injury (trauma)  Stroke  Tumor  Alcohol withdrawal –Seizure and altered mental state are two signs of delirium tremens, a sign of alcohol withdrawal –May result in death (35% if untreated; 5% if recognized and treated early –For about half the people in this age group, the cause is unknown

Drill of the Month7 Causes of Seizures For any age group For any age group –Idiopathic  Occurring spontaneously with no identifiable cause (common in children) –Conditions that irritate the brain  Injury  Certain prescription or recreational drugs and drug withdrawal  Sleep deprivation  High fever –Heat stroke –Infection

Drill of the Month8 Causes of Seizures For any age group For any age group –Conditions that deprive the brain of oxygen or fuel  Provoked seizure, usually non-epileptic; however these conditions can cause seizure in epileptic patients: History is important –Low level of oxygen  Abnormal heart rhythm  Carbon monoxide poisoning  Near drowning  Stroke

Drill of the Month9 Causes of Seizures For any age group For any age group –Conditions that deprive the brain of oxygen or fuel  Provoked seizure, usually non-epileptic; however these conditions can cause seizure in epileptic patients: History is important –Metabolic disorders  High/low level of sugar or sodium  Low level of calcium or magnesium  Kidney or liver failure

Drill of the Month10 Causes of Seizures For any age group For any age group –Structural damage to the brain  Noncancerous or cancerous tumor  Head trauma and intracranial bleeding  Stroke –Exposure to toxins  Lead  Strychnine

Drill of the Month11 Causes of Seizures For any age group For any age group –Fluid accumulation in the brain from eclampsia  Signs and symptoms of seizure  Altered mental status  Headache  Visual disturbances  Abdominal pain

Drill of the Month12 Causes of Seizures For any age group For any age group –Rare causes or triggers (reflex epilepsy)  Repetitive sounds  Flashing lights  Video games  Touching certain body parts

Drill of the Month13 Types of Seizures Two categories Two categories –Partial –Generalized

Drill of the Month14 Types of Seizures Partial Partial –Begin in a focal (limited or focused) part of the brain –Two categories  Simple partial seizure  Complex partial seizure

Drill of the Month15 Types of Seizures Simple partial seizure (Also called motor, sensory or Jacksonian seizures Simple partial seizure (Also called motor, sensory or Jacksonian seizures –“Jacksonian” named for John Hughlings Jackson who studied speech defects in brain disorders –Signs/symptoms  Tingling starts with fingers and moves proximally (epileptic march)  Twitching of muscles or extremities  Head turning  Visual changes  Dizziness

Drill of the Month16 Types of Seizures Simple partial seizure Simple partial seizure –Signs/symptoms  Aura –Sensation of smelling odors, seeing lights or colors, feeling of butterflies in the stomach –First aid  Do not restrain  Remove items to avoid patient injury and guide away from danger

Drill of the Month17 Types of Seizures Complex partial seizure (Also called psychomotor or temporal lobe seizures) Complex partial seizure (Also called psychomotor or temporal lobe seizures) –Often preceded by an aura –Signs and symptoms  Confusion and no memory of the episode  Abnormal behavior, possibly not noticed by others  Staring, sense of déjà vu, visual hallucinations  Aimless moving, fidgeting, repetitive motion  Smacking, chewing lips

Drill of the Month18 Types of Seizures Complex partial seizure Complex partial seizure –Signs and symptoms  Smelling unpleasant odors  Struggling if restrained  Altered mental state (loss of consciousness) –First aid  Do not restrain  Remove items to avoid patient injury and guide away from danger

Drill of the Month19 Types of Seizures Generalized seizures Generalized seizures –Involve larger areas of the brain –Affect both sides at the same time (compare to partial seizure affecting one focused part –Include four types  Tonic-clonic  Myoclonic  Absence or petit mal  Atonic

Drill of the Month20 Types of Seizures Generalized seizures Generalized seizures –Tonic-clonic (grand mal seizure)  Tonic refers to muscle tone or rigidity  Clonic refers to spasm  Signs and symptoms –May or may not experience an aura –Will often cry out before falling to the floor –Will become unconscious (altered mental state) –Will have major motor activity—thrashing of entire body –Will seize from 1 to 5 or up to 20 minutes

Drill of the Month21 Types of Seizures Generalized seizures Generalized seizures –Tonic-clonic (grand mal seizure)  Three distinct phases: Tonic (1) –Body becomes rigid for about 30 seconds –Patient may stop breathing but will resume spontaneously –Patient will rarely bite the tongue –Patient may lose bowel and bladder control

Drill of the Month22 Types of Seizures Generalized seizures Generalized seizures –Tonic-clonic (grand mal seizure)  Three distinct phases: Clonic (2) –The body begins to jerk violently for 1 to 2 minutes and up to 5 minutes –May have froth at mouth and drool –Face and lips may show cyanosis from breathing cessation

Drill of the Month23 Types of Seizures Generalized seizures Generalized seizures –Tonic-clonic (grand mal seizure)  Three distinct phases: Postictal (3) Post—after the seizure; -tictal— “blow” or “stroke” –May regain consciousness immediately but may be confused; or may remain unconscious for several hours –May feel sleepy, weak –May have a headache

Drill of the Month24 Types of Seizures Generalized seizures Generalized seizures –Myoclonic (myo—muscle; -clonic—spasm)  Occur in children in their first five years –Show brief jerking movement originating from CNS –Seizures involve both sides of body; may be subtle, barely noticeable or very dramatic, obvious –Appear as clumsiness or sudden unexplained jerk (as what happens during sleep to a foot or leg)  First aid: none required; refer to Protocols –After first significant event, medical evaluation is needed

Drill of the Month25 Types of Seizures Generalized seizures Generalized seizures –Absence or petit mal  Brief, 1 to 10 seconds; no warning or aftereffect  Temporary lapse of awareness, concentration; sometimes with staring  No major motor activity—seizure goes unnoticed  Start between ages 4 and 12, rarely begin after 20 and cease in adulthood but may develop tonic-clonic seizures  50 – 100 attacks a day interfering with thought activity and learning –First aid: none required; refer to Protocols  Child should have medical evaluation

Drill of the Month26 Types of Seizures Generalized seizures Generalized seizures –Atonic (also called “drop attacks,” astatic, or akinetic seizures; a—”no” meaning no muscle tone or rigidity, no muscle tension, flaccid)  Sudden head drop, loss of posture, collapse  Abrupt, without warning  Falls with force (drops), injures head and face (patients may wear head gear) –First aid: None required except to treat injuries; refer to Protocols  Should receive medical evaluation

Drill of the Month27 Patient Care Procedures Demonstrate care based on Protocols Demonstrate care based on Protocols –Initiate general patient care  Arrival and size-up  Patient approach  Initial assessment –Mental status –A,B,C,D,E –Clinical priority (1,2,3,4) –Disposition (mode, status)

Drill of the Month28 Patient Care Procedures Demonstrate care based on Protocols Demonstrate care based on Protocols –Initiate general patient care  History and physical exam/assessment –What was the patient doing/how was the patient feeling before the seizure? –What did the seizure look like? –How long did the seizure last? –Did the patient lose bowel or bladder control? –How did the patient respond after the seizure (awake, sleep, able to answer questions)? –What injuries did the patient sustain?

Drill of the Month29 Patient Care Procedures Demonstrate care based on Protocols Demonstrate care based on Protocols –Treatment  Presentation –Seizures and a neuromuscular response to an underlying cause  Epilepsy  Hypoxia  Hypoglycemia  Hypoperfusion  Head injury  CVA  Alcohol or drug abuse

Drill of the Month30 Patient Care Procedures Demonstrate care based on Protocols Demonstrate care based on Protocols –Treatment  Presentation –Consider recent history  Illness  Infection  Fever  Stiff neck

Drill of the Month31 Patient Care Procedures Demonstrate care based on Protocols Demonstrate care based on Protocols –Treatment: Care for adult and pediatric patients  If patient is still seizing –Position on side (no spinal injury) for oral drainage –Do not force anything into mouth –Do not restrain –Loosen restrictive clothing –Protect from injury –Consider cause of seizure

Drill of the Month32 Patient Care Procedures Demonstrate care based on Protocols Demonstrate care based on Protocols –Treatment: Care for adult and pediatric patients  After seizure stops –Identify and treat injuries –Suction airway if necessary –If cyanotic, provide oxygen (12-15 lpm NRB or 2-6 lpm nasal cannula—adults and peds) –If diabetic, place glucose paste (10-15 grams) between gum and cheek (in small doses for peds) –Use AVPU scale to assess mental status –Monitor vital signs and respirations –Encourage transport

Drill of the Month33 Altered Mental Status: Assessing and Managing Seizure Patients Student Performance Objective: Given information, resources, and opportunity for discussion and practice, EMTs will be able to: List causes, types, and signs and symptoms of List causes, types, and signs and symptoms of seizures, seizures, Describe patient care procedures, and Describe patient care procedures, and Demonstrate patient assessment and care. Demonstrate patient assessment and care. EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers.

Drill of the Month34 Altered Mental Status: Assessing and Managing Seizure Patients Review: Causes of Seizures Causes of Seizures –List causes by age group: 6 mos.-3 yrs., 2-14, after 25 –List 7 causes for any age group Types of Seizures and Their Signs and Symptoms Types of Seizures and Their Signs and Symptoms –Name two types of partial seizures; list signs and symptoms –Name four types of general seizures; list signs and symptoms Patient Care Procedures Patient Care Procedures –List the skill steps demonstrated during practice in caring for seizure patients