1. Chapter 19 Seizures and Syncope Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren

2. Objectives 1.Define key terms introduced in this chapter. 2.Describe the various ways that seizures can present (slides 11-13).slides 11-13 3.Discuss the pathophysiology of seizures (slides 14-15).slides 14-15 4.Explain the concerns associated with prolonged or successive seizures (slides 14-15).slides 14-15 5.Describe the assessment and emergency medical care of patients with tonic-clonic, simple partial, complex partial, absence, and febrile seizures (slides 16-28).slides 16-28 6.Anticipate bystander reactions to patients having seizures and take measures to stop unnecessary or inappropriate interventions (slide 32).slide 32

3. Objectives 7.Describe the assessment and emergency medical care of patients in a postictal state (slide 30-37).slide 30-37 8.Describe the assessment and emergency medical care of patients who are unresponsive, actively seizing, or in status epilepticus (slides 30-37).slides 30-37 9.Recognize situations in which the patient who is having or has had a seizure must be a higher priority for transport (slide 37).slide 37 10.Discuss the role of blood glucose determination in patients who have had a seizure (slide 34).slide 34 11.Discuss relevant questions to ask while gathering a history of the seizure activity (slide 34).slide 34

4. Objectives 12.Describe common causes of syncope. 13.Describe the scene size-up, assessment, and emergency medical care of patients with syncope, including differentiating syncope from seizure.

5. Multimedia Directory Slide 13Seizures and Epilepsy Video Slide 18Tonic-Clonic Seizures Video Slide 23Partial Seizures Video Slide 26Absence Seizures Video

6. Topics Seizure Syncope

7. CASE STUDY Dispatch

8. Respond to Southern Park Mall, main concourse, for a 23-year-old female who is seizing. EMS Unit 106 Time out 1717

9. First Responders indicate it is safe to enter Crowded mall due to craft fair Find patient supine and actively seizing First Responder protecting the patient’s head Upon Arrival

10. How would you proceed to assess and care for this patient?

11. Back to Topics Seizure

12. Convulsion Epilepsy Generalized tonic-clonic seizure Postictal state Back to Objectives

13. Return to Directory Click here to view a video on the topic of seizures and epilepsy.here Seizures and Epilepsy

14. Pathophysiology of Seizures Back to Objectives

15. Primary seizures –Generalized –Partial Secondary seizures Status epileticus

16. Types of Seizures Generalized Tonic-Clonic (Grand Mal) Seizure Back to Objectives

17. Aura LOC Tonic phase Hypertonic phase Clonic phase Postictal state Emergency care

18. Return to Directory Click here to view a video on the topic of tonic-clonic seizures.here Tonic-Clonic Seizures

19. Types of Seizures Simple Partial Seizure

20. Simple partial seizure Presentation Emergency care Simple partial seizure Presentation Emergency care

21. Types of Seizures Complex Partial Seizure

22. Complex partial seizure Presentation Emergency care Complex partial seizure Presentation Emergency care

23. Return to Directory Click here to view a video on the topic of partial seizures.here Partial Seizures

24. Types of Seizures Absence (Petit Mal) Seizure

25. Absence or petit mal Presentation Absence or petit mal Presentation

26. Return to Directory Click here to view a video on the topic of absence seizures.here Absence Seizures

27. Types of Seizures Febrile Seizure

28. Cause Ages Emergency care

29. Assessment-Based Approach to Seizure Activity Scene Size-Up

30. Signs of injury Protect from further injury Do NOT restrain a seizing patient Patient may refuse transport Back to Objectives

31. Assessment-Based Approach to Seizure Activity Primary Assessment

32. Assessing in the postictal state Assessing unresponsive patient Transport priority circumstances Back to Objectives

33. Assessment-Based Approach to Seizure Activity Secondary Assessment

34. Head-to-toe assessment Vital signs BGL History Medications Back to Objectives

35. Signs and Symptoms Convulsions Rigid muscular contraction Excessive saliva Urinary/bowel incontinence Chewing movement

36. Assessment-Based Approach to Seizure Activity Emergency Medical Care and Reassessment

37. Emergency Medical Care Position patient Maintain airway Suction Assist ventilations Prevent injury Maintain O 2 therapy Transport Reassess Back to Objectives

38. Syncope Back to Topics

39. Syncope Causes Treatment

40. CASE STUDY Follow-Up

41. Primary Assessment Patient’s sister is on scene Patient is still seizing Patient has history of seizures; sister assisted patient to ground First Responder opening the airway RR:18, irregular and shallow; P: 110 CASE STUDY

42. Primary Assessment Seizure abruptly stops RR: now 20 and regular; P: 110; skin warm and moist CASE STUDY

43. Secondary Assessment Patient becoming more oriented States seizure was not unusual for her A: none M: Tegretol P: none other than seizures L: one hour ago E: walking in the mall when she sensed the aura CASE STUDY

44. Treatment and Reassessment Patient refuses transport Contact medical direction Document history and physical exam Patient and sister sign refusal form CASE STUDY

45. Treatment and Reassessment Reassess vital signs Advise patient to contact 911 if she experiences another seizure CASE STUDY

46. 34-year-old male struck in the head by a falling brick at a construction site As you arrive, the patient is having convulsive-type movement You note obvious trauma to the head Blood and vomitus are coming from his mouth Critical Thinking Scenario

47. Radial pulse is 142 bpm Skin is moist and warm Cyanosis is noted to the nail beds No other injuries are noted Critical Thinking Scenario

48. 1.How would you manage the airway in this patient? 2.Would spine injury management be a consideration? 3.What type of seizure do you suspect the patient is experiencing? 4.What do you suspect is the cause of the seizure? 5.What emergency care would you provide for the patient? Critical Thinking Questions

49. Reinforce and Review Please visit www.bradybooks.com www.bradybooks.com and follow the myBradykit links to access content for the text.