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CONVULSIONS OR SEIZURES

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PHYSICAL INFORMATION

Vital signs
Neurological assessment, which includes any evidence of
considerable change in degree of consciousness
Particulars (location, length of time, severity, and
recurrence, etc. ) of any seizure activity, including
local or generalized motor activity, intestinal or
bladder incontinence, or behavior changes
Specifics of any injury or problems affiliated
with the convulsion or seizure

HEALTH CARE BACKGROUND

Patient’s age and sex
Any history of seizure disorder or actual seizure
activity
All present prescription drugs, including any recent
adjustments, particularly medications affiliated with
enhanced seizure probability
All present diagnoses
Date and time of any recent or current seizure
activity
Contrast of any current seizure activity related
to regular patterns
Relevant and recent laboratory or diagnostic examination results,
particularly BMP, calcium, and anticonvulsant blood
levels

Nonspecific Hints That Suggest the Existence of
Convulsion/Seizures:
One or more of the subsequent clues may signify
the presence of seizures (although no single
clue indicates with confidence that seizures
are existing. ) In patients with moderate to
severe communication difficulties (aphasia,
cognitive impairment, language limitations, etc.),
it is important to observe and document these
nonspecific signs and to look for additional analysis
for possible seizures if any clues are observed.
These symptoms usually last a very brief time
(such as 2 minutes) in the course of a seizure; some
indicators may last for up to a weeks time after a
selzure.
Become a Seizure Detective:
Altered mental state
Disorientation
Disrobing
Dizziness
Falls
Language changes (such as slurred speech)
Lapse of awareness
Memory disturbance
Inexplicable confusion
Unresponsive; staring off into the distance
Wandering.

Witnessing a patient experiencing a seizure may be very dramatic, but remember to stay calm as most seizures resolve on their own within 1 – 2 minutes. Be sure to see the patient who seized immediately, even if the patient has recovered.

QUESTIONS (may need to ask witnesses some questions)

Is the patient still having a seizure and how long has it lasted?
Patients who are actively having seizures are at risk of hypoxia, aspiration, metabolic acidosis, hyperpyrexia and cerebral oedema, ultimately leading to irreversible cellular damage.
What type of seizure was witnessed? Was the seizure generalized, tonic-clonic, or focal?
Was there a preceding aura of postictal drowsiness?
Was the patient incontinent of urine?
What is the blood pressure? (Palpate for the femoral pulse, which if present indicates a SBP of at least 70 mmHg. Sinus tachycardia and hypertension are common and usually settle over 10-30 minutes.)
What is the patient’s current level of consciousness?
Has there been any secondary damage (head, tongue, other injury)?
Does the patient look well (comfortable), sick (uncomfortable or distressed) or critical (about to die)?
What is the respiratory rate? (increased rate is normal as patient recovers)
What is the temperature? (A mildly raised temperature is usual, but should settle rapidly. A persistent temperature 38C requires a search for an infection. Perform blood cultures, CXR, MSU, CT, then LP. A temperature 39.5C indicates hyperthermia. Urgent cooling is necessary.)
What is the fingerprick glucose result? (Hypoglycemia must be treated.)

CONDITIONS THAT MAY MIMIC A SEIZURE OR POSTICTAL STATE

Pseudoseizure
Syncopal episode
Narcolepsy, cataplexy (including following laughter)
Transient global amnesia
Movement disorder (e.g., hemiballismus, choreo-athetosis, tics, Tourette syndrome, myoclonic jerks)
Complicated migraine
Dystonic reaction
Carpopedal spasm from hyperventilation
Decerebrate posturing

SEIZURE PRECAUTIONS

Place the bed in the lowest position
Keep the side rails up and pad with a rolled-up towel or blanket
Provide a firm pillow, commence oxygen and keep suction handy
Keep the patient in bed until reviewed medically, in the lateral position to avoid aspiration
Provide direct supervision when the patient uses sharp objects

MAJOR THREAT TO LIFE

Hypoxia
Aspiration
Hyperthermia
Cerebral oedema (if seizures continue more than 1 hour)

Moderate to severe communication problems (aphasia, cognitive impairment, language barriers, etc.) are considered nonspecific clues and should be observed and documented. If any clues are also observed, evaluate for possible seizures. The nonspecific and specific clues may only last 2 minutes during a seizure or may last up to a week after the seizure.

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