Seizures.
 

"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.
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.

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 .
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?

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

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.

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

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?

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

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

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?

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.

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.

Seizures
 

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.

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