Seizures.

[lrd]

"BTW- why not post a new thread about Seizures in this forum... everyone needs to review basic TX , Do's and Don'ts and helpful tips for the family members with epilepsy." Sacamuelas

With Eagle5US's permission, I will post my original question and his answer.

lrd: If we are out in the woods somewhere and I run out of medicine because we are stranded -- or more likely, I don't get enough sleep -- and begin seizing, is there anything my family can do to make me stop? I have been medicated (Dilantin) for so long (31 yrs) that my seizures are very few and far between...so when I do seize, it is very severe and the last time I seized 3 times before the docs could get me to stop. When I was younger, I would have a "mild" grand mal seizure, take a nap, and be recovered the next morning. Now, they are so severe that it takes weeks to fully recover and usually involves a hospital stay. I haven't had a seizure since 1992, and the longer I go the more worried I get about the strength of the next one -- especially if we are out in the boonies somewhere. Any advice for my family, besides protecting my head and making sure I don't swallow my tongue?

Eagle5US: Sooooo glad you are well controlled with your siezures. They can be quite the frightening encounter for everyone involved.
Unfortunately...you have the basic idea IF you should ever experience another one. A couple of things though...
If you are going to be in the wild wild wood...consider having a "siezure kit" with you. Easy to make out of household stuff. It should have a bite stick (tongue depressor with tape or a commercial model) to prevent you from breaking your teeth or biting your tongue, some instaglucose or other sweet shelf stable source of dissolved sugar (siezures use an incredible amount of energy and sugar stores...violent siezure activity can often result in low blood sugar...a bulb syringe for suction of secretions,and a rag for GP and a spare pair of panties (to change into afterwards).
Protection of your melon is foremost, body parts second. Make sure everyone is educated on your condition and even run a scenario or two with EVERYONE who you are going out with so they ALL know what to do in case you have a siezure. Otherwise it will be your luck to be with the ONE person who is clueless...and it could cost you your life.
You should not be restrained during your activity, and should be placed in the recovery position for your post-ictal period. You of course know this part...once you regain consciousness...simple fluid rehydration and if necessary, the sugar compound IN PARTS...NOT ALL AT ONCE can be tolerated until you are able to stand again.
BTW: the whole swallowing your tongue thing is a myth...it actually can't fold backwards...but it can slide back to cover your airway.
I hope this helps a little...if I didn't really answer your Q, let me know and I will try again.
Like Eagle said, it is a very unsettling experience for those who have not seen a seizure before. I've had them in the classroom, on the school bus, in a choir loft, at the mall (Mark and I were looking at mattresses so I'm not sure if half the people watching even knew what was happening), and at home alone. Most of them were in the early years when I was still growing and the doctors were adjusting my dosage. The first time I seized my best friend had just given me a cough drop; everyone thought I was choking and treated me accordingly. So the scenarios are:

1. 13 YO child (86 lbs) who recently put something in her mouth
2. 17 YO on a bus/public transportation
3. 23 YO in a public area
4. 45 YO in statis epilepticus

What would you do? What would you recommend for family members to do and not do? What treatment items should be kept in the home and what can be substituted for them?

NOTE: A very small person can be very strong when seizing.
NOTE II: Protect your head. A cracked skull can change your life.

[Sacamuelas]

LRD-
Eagle gave a good treatment protocol for epileptic seizures in post you quoted. Each of your scenarios will basically be treated the same way. Only Tx difference is I would not place anything into the mouth for reasons explained by CRIC and myself in the Link to:FAK (home) thread (http://www.professionalsoldiers.com/forums/showthread.php?s=&threadid=1319&perpage=15&pagenumber=1) .
to continue on your threads topic...

To ALL-
Besides Dx'd epileptics...
What are some of the more likely causes of seizure type activity in your patients? How do you differentiate clinically between them?

[Sacamuelas]

Originally posted by Sacamuelas
LRD-
Eagle gave a good treatment protocol for epileptic seizures in post you quoted. Each of your scenarios will basically be treated the same way.

OOps... didn't read ALL the scenarios.. the status epilepticus needs activatin of emergency services or in 18D land...administer medication

[Surgicalcric]

EMS should be summoned for all the scenarios. You should never take a 'wait and see' position even with persons who have a history of epilepsy or other seizure history. Remember, when a person is seizing they are not breathing and if they seize long enough they will arrest from hypoxia. Better to have them on the way then not and the patient arrest. Also, unless you know the origin of the seizure the patient will require evaluation by a MD to determine the cause. NEVER wait, bad things happen when people wait. (sorry Sacamuelas)

Other than protective care there is nothing the layperson can do to treat the seizure once active. Once the seizure itself is addressed or has ended in the case of the layperson you would treat the Cause which leads me to the questions posed by our resident Dental Care Professional.

Remember, in the prehospital setting, determining the origin of the seizure activity is less important than managing the complications and recognizing whether the seizure is reversible with therapy. Some of the more common causes, and their clinical presentations as seen, in the pre-hospital setting, are:


Stroke AKA Cerebrovascular Accident- hemiparalysis; unequal pupil size or lack of pupillary response on one side; slurred speech; dizziness; abnormal respiratory pattern (Cheyne-Stokes, hyperventilation, Ataxic, Diaphragmatic breathing, Apneustic respirations); increased ICP as evidenced by Cushing’s Triad; significant PMH to include but not limited to: HTN, Diabetes Mellitus, previous CVA.

Trauma(head)- Physical presentation of trauma; recent history of trauma; increased ICP (Cushing's Triad).

Poisoning, including ETOH- signs of poisoning if animal/insect induced (bites, stings). Lethargy, confusion, N&V, abdominal pain, blurred vision, tachypnea, shortness of breath, and/or witnessed ingestion with ingested toxins. Red flushed skin, hx of abuse, hx of recent use, signs of use with ETOH poisoning.

Hypoxia- cyanosis; diaphoresis; low SAO2; low ETCO2; hx of chronic pulmonary disease (COPD, Asthma, Emphysema, Bronchitis); anxiety prior to seizure activity

Hypoglycemia (low BGL)- diaphoresis; hx of diabetes mellitus; altered mental status prior to seizure; low Blood Glucose Level

Infection- Hx of recent surgical procedure; warm flushed skin over/near surgical site

Brain Tumor- history of tumor; see Stroke for other S/S.

Drug Overdose- Signs of overdose; hx of drug use/abuse.

Eclampsia- Hx or presentation of gestational hypertension

Metabolic abnormalities- hx of metabolic problems (anorexia, diabetic ketoacidosis, Thiamine deficiency, kidney or liver failure)

Most of the symptoms above will need to be noted prior to onset of seizure. The postictal state that follows the seizure will mimic many of the S/S of the above disease processes.

[lrd]

Surgicalcric: I'm not sure if I understand all of the terminology you used. Did you cover heatstroke?

[Sacamuelas]

Nope.. but that is another good one Lrd.

Good post Cric. :cool: I must admit to NEVER having called EMS for a seizure, but then again... ME PREPARED!! LOL

Other causes commonly seen?

[Surgicalcric]

lrd: Forgot to add heatstroke. Thought I would leave a few for others. I sometimes monopolize here and am trying to let others have a chance.

Also did not add:

migraines
psychosis (panic attacks)
abnormal cardiac rhythms
unknown origin

[Maple Flag]

Another way I learned to look at the causes of seizures is the STOP EAT acronym:

S--Sugar - Lack of blood sugar or too much insulin

T-- Temperature - High temperature "cooking the brain" as in Heat Stroke or low temperature as in Hypothermia

O--Oxygen - Lack of oxygen to the brain

P--Pressure - Increasing intracranial pressure from swelling or an internal bleed in the brain

E--Electricity - Lightning, etc.

A--Altitude - High altitude can cause swelling in the brain

T--Toxins - Chemicals in bloodstream like alcohol

[Sacamuelas]

For you guys working in the desert areas....

Don't forget Hyponatremia. It is much more rare than most of the others, but for the guys who frequent this board it is a possibility. Severe cases can lead to seizure and usually mimick the s/s of overheating. Remind your guys to drink water with electrolytes(not just plain H20) when replenishing mass quantities of fluid after hard work.

As to differentiating the cause, obviously the history either from the patient and/or the people standing around him before the incident are extremely important. That is why I posted the low Na+ cause... without asking the right questions one might become focused on heat stroke only without addressing the other possible causes.

Any others common ones?

[myclearcreek]

Originally posted by Surgicalcric
psychosis (panic attacks)

Personally, I think this is what happened to the student taking the honors chemistry exam I was proctoring. The pressure on pre-med students is bad enough, but this one was in an early admission program and very young. No reason was ever determined for him and in the following year, he did not have another episode of which I was aware.

[Sacamuelas]

Originally posted by myclearcreek
Personally, I think this is what happened to the student taking the honors chemistry exam I was proctoring. The pressure on pre-med students is bad enough, but this one was in an early admission program and very young. No reason was ever determined for him and in the following year, he did not have another episode of which I was aware.

That or sleep deprivation combined with to much ephedra based stimulants and caffeine drinks from the local gas station the night before. Not that he was a drug head... I mentin that because a LOT of serious students turn to caffeine/or worse for late night studying before finals. I admit guilt now as the statute of limitations has run.:o LOL

DISCLAIMER: The above is a very bad idea to do for you younger members lurking...It is medically dangerous to mix caffeine with other stimulants.

[myclearcreek]

Originally posted by Sacamuelas
That or sleep deprivation combined with to much ephedra based stimulants and caffeine drinks from the local gas station the night before. Not that he was a drug head... I mentin that because a LOT of serious students turn to caffeine/or worse for late night studying before finals. I admit guilt now as the statute of limitations has run.:o LOL

DISCLAIMER: The above is a very bad idea to do for you younger members lurking...It is medically dangerous to mix caffeine with other stimulants.


Possibly. Six pack or more of Mountain Dew and OTC stimulants... ewwww. He wasn't old enough for a drivers license, but could've hit the soda machine in the dorm and used on-hand meds.

Your disclaimer is so right. This is a terrible thing to do to your body, even when the results are not so outwardly damaging.

[Team4medic]

OK, I just can't let it get by without saying a few things.

1. Throw away those damn bite sticks! That is 50 year old medicine. The most often used purpose of the bite stick is to break teeth by well intentioned people. When a person has his Grand Mal SZ, One of the first actions is for the jaw to lock shut. Whatever tonque is bitten already happened and trying to stop it with a stick is a futile effort. If you must us an airway, a nasal trumpet is the way to go. And don't fight the poor guy. people have avulsed muscles off the origins and dislocated shoulders due to the good samaratin holding him down. And I have yet to see anybody swallow their tongues! Can't be done!(except Gene Simmons maybe) The base of the tongue may obstruct the airway, easily fixed by doing the head tilt or jaw thrust

2. There is an enormous pressure to DO SOMETHING! about a sz in process. A few said the right thing, protect the patient is the main thing. Most seizures will be self linited and do not require meds. By the book, meds aren't even indicated until the sz has lasted 15 minutes. A little O2 and suction is nice. The other thing you should do is sit back and " enjoy the show" Seriously, you may help the victim a whole lot more if you can give an accurate description of the sz to the Doc's. Is it unilateralor bilateral? Did it seem to start one place and spread? HOw long did it last? Were they at alll concious during the sz? Were the eyes deviated? Where? How long was the post-ictal period? Any other external factors?(trauma, drugs, meds, environmental exposure)

3. oh yeah, one other thing. What is the most common etiology for seizures that present ti an ER???

Noncompliance with their meds! Far and away the most common.

[NousDefionsDoc]

Welcome Team4medic. Please feel free to fill out your profile or PM your credentials to one of the Admins or Eagle5US, the moderator of this forum, if you are uncomfortable posting them in the open. As per the welcome memo at the top of the forum.

[DoctorDoom]

x

[NousDefionsDoc]

Good thread indeed.

[lrd]

A while back I began wondering if having seizures from one origin made me susceptible to having seizures from other origins. I asked, and this was confirmed. In other words, I have seizures because of a head injury, but that makes me more likely to have seizures from heatstroke than someone who doesn't already have seizures.

Wouldn't this make it very hard to determine the cause of the seizure?

[NousDefionsDoc]

I would say the difficulty would depend on several factors.

Given the same examples you gave, if it is December, I wouldn't expect seizures from heat injury. And it doesn't matter to me in the field if you were more succesitable o not - point is, you have it now. See what I mean? A little common sense on the part of the medic can go a long way, as can the the simple question "What happened?"

Usually, what you see is what you have.

Just a thought.

[DoctorDoom]

x

[Doc T]

Originally posted by Team4medic


2. There is an enormous pressure to DO SOMETHING! about a sz in process. A few said the right thing, protect the patient is the main thing. Most seizures will be self linited and do not require meds. By the book, meds aren't even indicated until the sz has lasted 15 minutes.

is this the military protocol? Not to give meds unless a seizure lasts 15 minutes? I agree that most seizures last less than 3 minutes and do not require meds but the protocols I am familiar with recommend meds if sz last longer than 5 minutes...

Just curious what book you are referring to?

thanx.

doc t.

[Surgicalcric]

Protocol for admin of meds for seizures here is 5 minutes from onset of first or as soon as possible after onset of each subsequent seizure.

I cant imagine waiting 15 minutes.

[Sacamuelas]

Ahhh...the sweet sound of professional hazing. :D

I was writing a rebuttal and decided to delete it out of "niceness" to our new medic. LOL

Team4Medic... Welcome. Please make sure you comply with NDD's profile request as we are all curious as to what "the book" you have been reading is. HaHA

Note, Most of your post that you felt you "just can't let it get by without saying a few things" is just a rephrased version of information already covered in this thread. Well, except that part which was wrong concerning the 15 minute seizure. Haha

Don't take this the wrong way.. this is actually a TMC 14 version welcome (if your legit).

[Doc T]

Originally posted by Sacamuelas
Ahhh...the sweet sound of professional hazing.



no hazing involved...just critiquing. Such a more pleasant word.....:)

[DoctorDoom]

x

[Surgicalcric]

I was taught SE is continuous seizure activity lasting 30 minutes or longer or recurrent seizure(s) without an intervening period of consciousness.

Again, I am not waiting 15 minutes. If the PT is seizing when I arrive they are getting either Valium or Ativan as soon as IV access can be established, or rectally if IV access is unattainable.

And speaking of Valium how many, by a show of keyboard stroke, have given valium rectally, either Ped or Adult?

[NousDefionsDoc]

And speaking of Valium how many, by a show of keyboard stroke, have given valium rectally, either Ped or Adult?

To a patient?

[NousDefionsDoc]

:D

[Surgicalcric]

Yes to a patient.

[NousDefionsDoc]

Originally posted by Surgicalcric
Yes to a patient.

Ok, never mind.

[Surgicalcric]

I am afraid to ask.

:munchin

[DoctorDoom]

x

[Surgicalcric]

Originally posted by DoctorDoom
...I have never given anyone, ANYONE, PR Valium... That was not convincing enough for me.

I have, but only to Ped patients.

[Sacamuelas]

Let's get back on track....

Originally posted by Surgicalcric
If the PT is seizing when I arrive they are getting either Valium or Ativan as soon as IV access can be established, or rectally if IV access is unattainable.

And speaking of Valium how many, by a show of keyboard stroke, have given valium rectally, either Ped or Adult?

Quick Pharmacy note to ponder and remember...

If you give Valium(diazepam) or Ativan(lorazepam) and respiratory depression symptoms occur, what medication is given as the antagonist? Is it the same drug or a different one for each of the two anticonvulsants?

[Surgicalcric]

Depending on the length of transport they will either get bagged until I get to the ED or they will get an ET.

If in the ED or once in the ED Flumazenil (romazicon) is the DOC for Benzo overdose/overmedication. It is not an approved drug for field admin here in SC (yet).