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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
  • Identify and address cause where possible
  • Full Vital Signs Survey, particularly GCSBGLPulse 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 mental retardation or brain damage
  • 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
Key Terms & Links
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