2. Pre-hospital Management P.J. Wynnyk, M.D.

3. Biochemistry of Seizures

4. Definitions Simple Partial -focal seizure with no decreased in LOC Complex Partial-focal seizure with a decrease in LOC Tonic Clonic-i.e. “Grand Mal” convulsion; can start as a partial seizure and become generalized or start as a generalized seizure from the outset

5. More Definitions Absence- type of generalized seizure with decreased LOC Status Epilepticus- >5min of generalized seizure activity or 2 seizures occurring close together without full recovery in between Aura- prodrome heralding the onset of a seizure (can be certain smells, sounds, visions, or behaviors)

6. Even More Definitions Postictal- state of stupor/confusion after a seizure that varies in length often accompanied by headache, sore muscles, and amnesia to the event Pseudoseizures- fake seizures associated with psychiatric conditions or malingering

7. Deciphering The Lingo “When he was small he got the smilin’ mighty Jesus. Soon after that he done fell out with the fits. We carried him to the doctor who said he had skeezers and he been on peanutbutter balls ever since.”

8. Translation “When he was child he contracted spinal meningitis resulting in the seizure disorder for which he is prescribed phenobarbitol.”

9. Factoids Most seizures resolve spontaneously in 3-5 minutes Most people die from seizures due to aspiration and trauma (MVC, falls, drowning, etc.)

10. Management Scene Safety Assess- be especially cognizant of the high association of traumatic injury and seizure Protect the patient from further injury Do not try and restrain a patient actively seizing Oxygen administration Call for ALS

11. More Management Check serum glucose if qualified Left lateral decubitus position with good suction to help prevent aspiration Minimize stimulation during transport (i.e sirens, flashing lights, and Techno music on the stereo) Establish i.v. if possible Monitor placement

12. Even More Management Intravenous dextrose if blood sugar <60 Benzodiazepines- first line treatment in acute seizures

13. Midazolam (Versed) Benzodiazepine with short onset and short half-life (works quickly and wears off quickly) Given i.v./i.o. (slowly) or intranasally in the EMS setting ADULT: 5mg iv/io/in and may repeat 5mg in 5 minutes if needed KIDS: 0.15mg/kg iv/io/in initially to a max dose of 5mg (age 0-2yrs) and 10mg (>2yrs)

14. Eclampsia Seizures associated with pregnancy (>20weeks gestation) Usually with elevated blood pressure (>140/90) Treat with magnesium (4 grams i.v.)

15. OH YEAAH!....... Men can get pregnant…………………

16. Febrile Seizures #1 cause of seizures in kids Generalized and lasts <15minutes Age 6 months- 5 yrs old Kid is usually in good health otherwise Treatment is fever reduction (cooling measures if >102F)

17. Good things to Document Length and number of seizures PTA Incontinence Postictal state Use of ETOH, benzos, other drugs (tramadol, cocaine, amphetamine) List of any seizure meds

19. TH-TH-TH-TH-TH-TH-TH-

20. Questions?