1. Tracy Evans, RN, MS, MPH, EMT-P February 2000
Managing Seizures
Tracy Evans, RN, MS, MPH, EMT-P
February 2000
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2. Tracy Evans, RN, MS, MPH, EMT-P February 2000
Shake, Rattle and Roll
Tracy Evans, RN, MS, MPH, EMT-P
February 2000
Tracy Evans. Copyright, All rights reserved.

3. Tracy Evans. Copyright, 2000. All rights reserved.
Seizure
Sudden discharge of neurons that results in prolonged electrical activity of the brain
Abnormal neuron firing
Interferes with normal brain function
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Incidence
No statistics on total number of Americans having seizures annually
4 million Americans have epilepsy
+ males
+ African-Americans
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Epilepsy
A chronic seizure disorder
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Anatomy
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Causes of Seizures
Nerve Cell Structural Changes
Hypoxia
Trauma
Tumors
Vascular Insufficiency
Ionic Changes pH
Electrolyte Imbalances
Hyperventilation
Metabolic Changes
Hypoglycemia
Fever
Stress
Fatigue
Drug or Alcohol withdrawal
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Classification
Partial
Generalized (Grand Mal)
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Partial
Portion of the brain is effected
Possible change in mental status
Classified as Simple or Complex
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Simple vs Complex
No change in mental status
Affect brain activity in temporal lobe or limbic system
Change in mental status
Affect any area of the brain
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Generalized
Change in mental status
Focused assessment will reveal tonic-clonic activity
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14. Stages of Seizure Activity
Aura
Prodrome
Tonic Phase
Clonic Phase
Postictal State
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15. When is a seizure too long?
Most seizures last 2-3 minutes
Recognition of a prolonged seizure can be life-saving if action is taken
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Caution
Assessment for seizure activity and changes in activity are crucial
Cessation of tonic clonic activity does not always indicate cessation of seizure activity!
The muscles may be unable to meet metabolic demands.
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Caution
Not all seizures are caused by epilepsy!
Rule out trauma and other possible causes before assuming the patient is epileptic!
Pregnancy in the later stages, can be the cause of seizures because of Eclampsia.
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18. Assessment of Seizure Patient
Perform initial assessment, SAMPLE, OPQRST
Patient is a priority if:
Seizing longer than 10 minutes
Unresponsive between seizures
Pregnant
Remains unresponsive for a prolonged period of time after seizure has stopped
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Signs and Symptoms
Aura or Unresponsiveness
Tonic-clonic activity
Hyperventilation, excessive salivation, exhaustion
Trauma to lips, mouth, tongue
Cyanosis during seizure
Incontinent or urine or feces
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20. Management of Seizures
Protect the patient from injury
Maintain the airway, suction as needed
Position lateral recumbent
Never place any object in the patient’s mouth or between the teeth
Never try to forcibly restrain a seizing patient
If breathing is adequate give O2, 15 LPM by Non-rebreather Face, otherwise use BVM
Find out when the seizure started and how long it’s lasted
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21. Status Epilepticus A Dire Emergency!
A seizure lasting more than twice its normal duration
Two or more seizures without a lucid interval
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22. Critical Point Status Epilepticus is DYNAMIC
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23. Incidence of Status Epilepticus
50, ,000 cases per year
3% pediatric mortality
10% adult mortality
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24. Management of Status Epilepticus
Perform all care as previously outlined.
This is a dire emergency! Get a Paramedic Intercept!
This patient will require BVM ventilations, suctioning and 100% O2.
This patient is severely hypoxic and brain damage is possible!
Be ready for cardiac arrest
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Febrile Seizures
2-5% of previously healthy children will have a febrile seizure
Ages 6 months to 5 years
Generally self-limiting
Cool with tepid water. Never use alcohol baths or ice water to cool.
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26. Re-Assessment of Seizure Patients
Airway
Respiratory Effort
Hemodynamics
Neurologic Status
Re-evaluate continuously
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Neurologic Status
AVPU
Glascow Coma Scale
Neurological Status is a on a continuum from Awake to Unresponsive
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EEG
Recording of electric potentials based on the distributions of waveforms with different frequencies and amplitudes that are generated by the cerebral cortex of the brain
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29. Common Antiepileptics
Dilantin ®
Cerebyx ®
Tegretol ®
Depakote ®
Barbita ®
Zarontin ®
Neurontin ®
Lamictal ®
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Dilantin® - Phenytoin
Action: Unknown
Phenytoin is thought to stabilize neuronal membranes and limit seizure activity by modulation of voltage-dependent sodium channels of neurons, inhibition of calcium flux across neurons, and enhancement of sodium-potassium ATPase activity in neurons and glial cells.
Monitor blood levels
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31. Cerebyx® - Fosphenytoin
Action: Unknown
A prodrug of phenytoin
Immediately converts to phenytoin
100% Bioavailability
Less Alkaline
IM/IV
Monitor blood levels
Expensive
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32. Tegretol® - Carbamazepine
Action: Unknown
Thought to stabilize neuronal membranes and limit seizure activity by either increasing efflux or decreasing influx of sodium ions across cell membranes in the motor cortex during generation of nerve impulses
Monitor blood levels
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33. Depakote® - Valproic Acid
Action: Unknown
Probably inhibits brain levels of gamma-aminobutyric acid, which transmits inhibitory nerve impulses in the CNS
Monitor blood levels
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34. Barbita® - Phenobarbital
Action: Unknown
Probably depresses mono and polysynaptic transmission in CNS and increases threshold for seizure activity in the motor cortex
Monitor blood levels
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35. Zarontin® - Ethosuxamide
Action: Not clearly defined
A succinimide derivative that probably increases seizure threshold.
Monitor blood levels
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36. Neurontin® - Gabapentin
Action: Unknown
Structurally related to gamma-aminobutyric acid (GABA)
Does not interact with GABA and isn’t converted to GABA or a GABA agonist
Monitoring of blood levels is not necessary
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37. Lamictal® - Iamotrigine
Action: Unknown
May cause inhibited release of glutamate and aspartate (excitatory neurotransmitters) in the brain. This may occur by way of action at voltage-sensitive sodium channels
Monitor blood levels
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