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Introduction
A seizure is an abnormal paroxysmal discharge of cerebral neurons which manifests clinically as changes in motor, sensory, behavioural or autonomic function.
Read the complete article; Seizures in the Medical Library > Pathophysiology.
Clinical Presentation
Generalised seizure activity should be considered an emergency where:
- The seizure is prolonged (> 5 minutes), or
- Multiple seizures occur, or
- The patient doesn’t regain consciousness.
Focal seizure activity associated where:
- The seizure is prolonged (> 5 minutes) and is associated with a GCS ≤ 12.
Exclusion Criteria
Exclusion Criteria
Risk Assessment
- Protect the patient from danger where possible (move hazardous objects away from patient; pad beneath the patient’s head for protection. Restrain the patient only if needed to prevent injury.)
- Airway evaluation, management and vigilance during and after seizure activity is required
- Do not actively cool a febrile child by sponging as shivering will increase temperature
- The pharmacological management of other seizure types requires ASMA consult and authorisation
- Be aware of the potential for airway obstructions; trauma to the tongue is unlikely to cause serious problems, but trauma to teeth may do so if inhaled
Management
Primary Care
- Protect from injury whilst patient seizing
- Complete Primary Survey
- Open, clear and maintain the airway
- Suction if required
- Insert appropriate airway adjunct; consider NPA if trismus present (do not attempt to force an airway into the fitting patient's mouth)
- Lateral position if unresponsive (use left lateral position for pregnant women)
- Oxygen with assisted ventilation if indicated
- Open, clear and maintain the airway
- Identify and address cause where possible
- Full Vital Signs Survey, particularly GCS, BGL,
Pulse Oximetry and Temperature
- Repeat vital signs every 10 minutes (5 minutes if patient appears time critical)
- Consider patient’s normal conscious state when making an assessment, as patients with severe epilepsy may have underlying intellectual disability.
- Complete Secondary Survey once seizure has terminated
Intermediate Care (EMT / Level 2)
- Apply cardiac monitor if trained and authorised
- Consider administering glucose Gel if indicated (i.e. patient hypoglycaemic)
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Consider Priority 1 transport if seizure prolonged (> 5 minutes) or recurrent, pre-notifying receiving facility
Advanced Care (AP)
- Apply cardiac monitoring
- Establish Vascular access
- Administer Midazolam as per CPG
- Consider prehospital bloods
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Consider Priority 1 transport if seizure prolonged (> 5 minutes) or recurrent, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
- As per Advanced Care (AP) guidelines
Additional Information
Complications and side effects of seizures can include:
- Incontinence
- Secondary injury (including intra-oral trauma)
- Aspiration
- Hypoxia
- Hyperthermia
- Dysrhythmias
- Brain damage
- Death
References
References
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