Ch. 36 & 38 Flashcards
1
Q
seizure (defined)
A
abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain; may result in alteration in consciousness, motor or sensory ability, and/or behavior
2
Q
epilepsy (defined)
A
- two or more seizures experienced without a known cause (ie fever, tumor)
- chronic disorder with recurrent, unprovoked seizure activity, may be caused by abnormality in electrical neuronal activity and/or imbalance of neurotransmitters (ie GABA)
3
Q
how is epilepsy quantified (r/t # of seizures)
A
two or more seizures experienced without a known cause (ie fever, tumor)
4
Q
types of seizures
A
- generalized
- partial
- unclassified
- primary or idiopathic epilepsy
- secondary seizures
5
Q
generalized seizures
A
tonic-clonic/grand mal
- postictal state ( period of confusion immediately following seizure, then pt is fine)
6
Q
partial seizures
A
focal/local
- one cerebral hemisphere- complex or single
7
Q
unclassified seizures
A
seizures that can’t be classified due to lack of information
- not witnessed
- no EEG available
8
Q
primary aka idiopathic epilepsy
A
- not associated with any identifiable brain lesion
- we don’t know why it happens
9
Q
secondary seizures
A
- result from an underlying brain lesion, most commonly a tumor or trauma
- many diseases/disorders associated with s/s of seizure
10
Q
causes of seizures/ things that increase risk of seizure
A
- metabolic d/o: liver disease- ammonia goes up, brain swelling
- acute alcohol withdrawal!*
- electrolyte disturbances: low sodium
- heart disease: v-tach
- high fever: common with kids
- stroke: from increased ICP with brain swelling
- substance abuse: need hx of illicit drug use
11
Q
diagnostics for seizures
A
- EEG (want to mimic the way pt has a seizure: sleep deprived, no meds, no lotion, clean/clip hair- electrodes to scalp)
- CT/MRI (looking for tumor)
- ID underlying causes (labs, PMH)
- document before and after (want to know how long/length of seizure)
12
Q
drug therapy “rules” for seizures
A
- evaluate most current blood level of medication, if appropriate
- be aware of drug-drug and drug-food interactions
- maintain therapeutic blood levels for maximal effectiveness
- do not administer warfarin with phenytoin
- document and report side/adverse effects: fatigue common
13
Q
phenytoin special considerations
A
- cannot mix with sugar, ONLY saline
- very small window of therapeutic range- check blood levels!
- no warfarin!
- causes gum hyperplasia
- compliance issue b/c need blood levels checked
14
Q
seizure medication: AEDs (anti epileptic drugs)
A
- Carbamazepine: maintenance
- Diazepam: rescue
- Lorazepam: rescue
- Divalproex: maintenance
- Valproic Acid: maintenance
- Gabapentin: maintenance
- Lamotrigine: maintenance
- Levetiracetam: maintenance
- Phenobarbital: maintenance *
- Phenytoin (aka dilantin): maintenance; through IV
15
Q
patient may be prescribed up to __ medications simultaneously for intractable seizures
A
patient may be prescribed up to 3 medications simultaneously for intractable seizures
16
Q
seizure precautions: patient positioning
A
- turn patient to side if possible
- do NOT force patient to move to side
17
Q
nursing management when seizure occurs (stages)
A
- observe and document
- patient safety
- medications
- need medical history to ID why seizure is happening
18
Q
nursing management when seizure occurs: observe and document
A
- onset of seizure if witnessed
- behavioral manifestations
- determine if patient is oriented by asking questions and document responses
- document end of seizure
19
Q
nursing management when seizure occurs: patient safety
A
- position: side lying
- no restraints
20
Q
nursing management when seizure occurs: medications
A
- Lorazepam
- Diazepam
- Diastat
- IV phenytoin
21
Q
status epilepticus: actions
A
- establish an airway
- ABGs
- IV push lorazepam, diazepam; rectal diazepam (rescue meds)
-lorazepam is like jelly, insert small amount of NS flush into lorazepam to make easier to draw up - loading dose IV phenytoin (maintenance meds)
22
Q
what is status epilepticus?
A
MEDICAL EMERGENCY- loss of neurons may occur (no oxygen to the brain)
- prolonged seizures lasting more than 5 minutes or repeated seizures over the course of 30 minutes
23
Q
surgical management of seizures
A
- vagal nerve stimulation (VNS)
- conventional surgical procedures
- anterior temporal lobe resection
- partial corpus callosotomy
24
Q
surgical management of seizures: VNS
A
implanted medical device to send electrical impulses to vagus nerve
25
surgical management of seizures: anterior temporal lobe resection
a neurosurgical procedure that removes the front part of the temporal lobe of the brain to treat drug-resistant epilepsy
26
surgical management of seizures: partial corpus callosotomy
a surgical procedure that separates the front two-thirds of the corpus callosum, the bundle of nerve fibers that connects the two hemispheres of the brain
27
patient/family education regarding seizures
- 30% of persons with epilepsy have intractable seizures.
- Alternative employment may be needed.
- No driving if seizure activity within 6 months.
- Vocational rehabilitation may be subsidized.
- Antiepileptic drugs (AEDs) may not be stopped, even if seizures stop.**!!
- Refer limited-income patients to social services.
- All states prohibit discrimination against people who have epilepsy.
- Some persons with seizures develop pseudoseizures
28
what % of people with epilepsy have intractable seizures?
30%
29
no driving for a person who had seizure activity within the last ___ (time period)
no driving for a person who had seizure activity within the last 6 months
30
what is a stroke?
a stroke or CVA occurs when the blood flow to the brain is obstructed, causing deprivation of oxygen and nutrients, which are essential for functioning
- the obstruction may be caused by a clot (ischemic) or a hemorrhage (bleeding)
- need to know which type of stroke (ischemic or hemorrhagic)
- ischemic stroke is more common, more nursing interventions
- lack of blood flow leads to cell death
31
risk factors for stroke: modifiable
- smoking
- obesity
- hypertension (higher risk for hemorrhagic stroke)
- diabetes mellitus
- elevated cholesterol
- blacks 2x higher than whites- access to healthcare, psychosocial reasons
32
risk factors for stroke: non-modifiable
- familial: first degree relative with history of hypertension, atherosclerosis disease, aneurysm (anywhere in the body)
- if fam member has hx of aneurysm, the patient should get a head CT just incase
- women (more prevalent post-menopausal; the idea is that women live longer than men)
- hispanic, native american, african ancestory
33
transient ischemic attack (TIA) definition
transient episode of reversible ischemia in the CNS typically <1hr, up to 24hr
- "mini stroke"
- little blockage, blood isnt getting through, then all of a sudden the blood gets through
- if patient has multiple TIAs- red flag that they need to change lifestyle or will experience a stroke
- pt shows stroke sx, we rule out CVA, then back track to TIA
- difference between CVA and TIA: TIA symptoms resolve- function back, speaking clearly
34
TIA symptoms
- depend on region- affected by emboli
- hemiplegia
- difficulty with speak
- weakness
35
ischemic stroke is when
a clot blocks blood flow to an area of the brain
36
hemorrhagic stroke is when
bleeding occurs inside or around brain tissue
- ie aneursym bursts
37
types of hemorrhagic stroke
radiologist is the one that diagnoses the region
- intracerebral hemorrhage (ICH)
- subarachnoid hemorrhage (SAH)
- aneurysm
- arteriovenous malformation (AVM)
38
ischemic stroke types
(blocked vessels- most commonly carotid- do a carotid ultrasound)
- embolic stroke ("moving clot" clot breaks off in the body somewhere and travels to the brain where it gets stuck)
- thrombotic stroke (clot forms and blocks vessel)
39
stroke incidence and prevalence
- 5th leading cause of death in US
- women have higher prevalence than men post-menopause
-onset of symptoms may be slightly different
- stroke belt: a section of states that are at a higher risk mostly due to modifiable risk factors (lifestyle factors. limited access to healthcare, etc.)
- 4+ million stroke survivors in the US
40
in a stroke, "act F.A.S.T."
face: one-sided droop, ask pt to smile
arms: one arm weak or numb, ask pt to raise both arms, one arm drift downward
speech: slurred, ask pt to repeat simple sentence- repeated correctly?
time: if person shows any sx, call 911 or get to hospital immediately
41
stroke: pt history
- onset of sx: time, type of sx (HA, weakness)
- when was patient's last known well (last time they were definitively known to be well/at baseline- need to know to give t-PA)
- use of medications, OTC (current use)
- medical hx: a-fib (huge clot risk), including recent events (MI, stroke or TIA, trauma, surgery, GI bleed or any bleed in the body)
- know if pt is diabetic- sx of low blood sugar are similar to stroke- make sure to get a blood sugar before doing anything else
42
stroke diagnostics: labs
- blood glucose (check this first!!)
- PT, INR, aPTT (going down the road of if going to give thrombolytic or anticoagulant- need to check these levels before giving meds)
- elevated H&H, WBC
- hemoglobin A1C (can do later)
*note blood levels do not diagnose stroke
43
stroke diagnostics: imaging
- CTP and/or CTA using contrast dye (CT is definitive dx stool)- think working IV, allergy to iodine/dye?, impact on kidneys d/t contrast dye (monitor kidney function), stop metformin for 48hr give IVFs for DM pt
- MRA (similar to MRI- usually do it down the road, facility specific)
- ultrasound (used to view carotid arteries/vessels, NOT the brain)
*initially will not see blockage on CT, will only see bleed on CT (white spot in brain): this is how we dx type of stroke
- see nothing on CT: ischemic stroke
- see bleed on CT: hemorrhagic stroke
44
"time is brain" meaning
with a stroke,
- up to 1 million brain cells may die each minute without treatment
- 3 hour window from beginning of symptoms to administration of thrombolytic
45
nursing priorities with stroke
- activate stroke team/call stroke alert
- 3 hr window time for tPA
- may rule in for intra-arterial interventions up to 6 hours
- anticipate stat orders and prepare patient
-brain CT (non-contrast) or MRI
-labs: glucose, PT/INR/aPTT
-EKG: looking for a-fib, new-onset
-vitals
- GCS (need to know baseline as well, any change from baseline is worrisome): goal is to have HIGH number
- NIH stroke scale (NIHSS): goal is to have LOW number
46
target time with stroke: "door to needle time"
latest goal is 45 minutes (no more than 3 hours from onset of sx)
- time patient arrives at hospital to time thrombolytic (activase (t-PA)) is given to patient
<10 min: neuro assessment *last known well, when did the sx start, document everything
<15 min: stroke team notified, heart monitor, start IV
<25 min: CT initiated
<45 min: CT and labs interpreted, patient comfortable in bed
<60 min: t-PA given to patient if eligible
47
stroke medication: thrombolytic therapy
to loosen clots/"cause" bleeding- for ischemic stroke only (clot strokes)
- activase (t-PA) *blood pressure must be <180/105 to give t-PA
-labetalol may be administered to reduce BP
- need to know patients PMH including recent surgeries because we may not be able to give with thrombolytic depending on how recent the surgery was
48
stroke medication: anticoagulants
to prevent clots
- Warfarin, apixaban, dabigatran, edoxaban and rivaroxaban
*not to be used within 24 hours of t-PA
49
stroke medication: lorazepam and antiepileptics (phenytoin) are used for ___
- May be used for seizure prophylaxis
50
stroke medication: statins
- Atorvastatin (Lipitor), Lovastatin (Altoprev), Pravastatin (Pravachol), Rosuvastatin (Crestor, Ezallor), Simvastatin (Zocor)
51
stroke medication: CCBs
- Amlodipine (Norvasc), Diltiazem (Cardizem), Nicardipine, Nifedipine (Procardia), Verapamil (Calan SR, Verelan)
52
stroke medications
- stool softeners: to prevent straining and prevent increased ICP
- analgesics for pain: as needed for hemorrhagic stroke
- anti-anxiety meds: benzos also cover anxiety
- statins: long-term management; d/c pt on this
- CCBs: gets BP down
- lorazepam and other antiepileptics
-"pams" are rescue meds for seizures to stop; benzos
-antiepileptics are maintenance to prevent seizures
- anticoagulants
- thrombolytic therapy* for clot stroke only
53
activase (T-PA)
- <3 hrs of onset of symptoms!
- 4.5 hours for some patients
- May require Patient or Family Consent
- Bolus for 1 min then drip for 60 minutes
- need to know patients weight
- very expensive- dont drop it, even if you spike it but dont use it, return it to save hospital some money
- Prior to Administering – Nursing!
- Post t-PA infusion care – Nursing! (looking for improvement of sx, looking for bleeding)
- ICU 24 hrs
- Neuro checks/vs every 15 minute protocol
54
contraindications of activase (t-PA)
- Onset of symptoms unclear (i.e. wake-up stroke)
- Bleeding (recent surgery/known active/labs/meds-on blood thinners)
- outside of the 3 hour window (in rare cases, neurology may choose to give it)
- blood pressure 180/105 or higher (need to give antihypertensive to lower BP then reassess)
(*note -permissive HTN: 140s/150s systolic is okay, want BP a little high to increase pressure in brain d/t lack of blood flow to brain)
- Already improving; symptoms got better
55
interventional management for ischemic stroke
- medical management: tPA
- surgical:
-merci device (mechanical embolus retrieval in cerebral ischemia)
- carotid artery angioplasty with stenting
-endarectomy: scraping out the crud
56
hemorrhagic stroke: medical treatment
- Medications used to treat acute stroke
anticonvulsants, antihypertensives, osmotic diuretics (ie. mannitol- causes polyuria, edema, CHF, full of fluid- think lung sounds important)
- Reversal of anti-platelet or anticoagulant therapy: vit K, cryo, FFP
- Surgical intervention: craniotomy with clot evacuation
- Endovascular surgery with aneurysm clipping (think clamp on either end of vessel to prevent blood flow through the vessel)
57
hemorrhagic stroke: nursing measures
- Frequent monitoring of neuro status
- Low stimulation environment
- Blood pressure management
- Arrythmia detection
- Post operative care
- Dysphasia screening
58
s/sx of increased intracranial pressure (ICP)
- changes in LOC
- HA
seizures:
- impaired sensory and motor function
changes in VS:
- cushings triad: increased systolic BP, decreased pulse, irreg resp pattern
- vomiting
- changes in speech
posturing: (ominous sign to do something!)
- decorticare, decerebrate, flaccid
eyes:
- papilledema, pupillary changes, impaired eye movement
infants:
- bulging fontantels, cranial suture separation, increased head circumference, high pitched cry
59
increased intracranial pressure (ICP): management
- osmotic diuretics
- mannitol IV: use 0.22 micron filter
- hypertonic saline (2% or 3%)
- drainage of CSF
60
Joint Commission of Measures of Stroke Care
- Dysphasia screening
- DVT prophylaxis
- Consider thrombolytic therapy
- Antithrombotic therapy by end of day 2
- Stroke education
- Assess for rehabilitation
- Anticoagulation therapy for atrial fibrillation/flutter
- Discharge on statin medication
61
other tests and monitoring for stroke
- carotid ultrasound
- dysrhythmias monitoring
- nursing bedside swallow eval***
62
stroke: patient intensive care management
- cooling (normothermia)
- internal cooling, external cooling devices
-nursing: bedside shivering assessment scale
- neuroprotective drugs
- carotid artery angioplasty with stenting
- consider endarterectomy
63
AV malformation (definition)
- something a person is born with; congenital malformation
- usually incidental finding on CT
- can live normally, but increased risk of brain bleed
- weird collection of vessels without capillary bed
- type of hemorrhagic stroke cause
64
management of cerebral aneurysms
- minimally invasive techniques
- open craniotomy
-clipping
- interventional radiology
-coiling
- type of hemorrhagic stroke cause
- types: saccular, fusiform, ruptured
- will leave if not burst or small enough to not worry about/cause harm
65
clipping: post-op care
- position
- normal expectations
66
coiling (definition)
insert tiny platinum coils into aneurysm
- no skull incision, minimally invasive, quicker recovery
- go through groin
67
craniotomy: nursing post-op care
- Monitoring for ICP and Neuro deficits
-GCS/Pupils
- Normal Findings: periorbital edema and ecchymosis
- Positioning: midline, HOB elevated 30°
- Dressing
- Lab
- Meds: seizure, anxiety, pain, etc.
- NPO for 1st 24 hrs
- Potential Complications: bleeding more, infection (monitor temp, give prescribed ABT)
68
potential complications from a craniotomy
- impaired physical mobility & self-care deficit
- disturbed sensory perception
- unilateral neglect
- impaired verbal communication
69
interventions for impaired physical mobility and self-care deficit
- Range-of-motion exercises for the involved extremities
- Change of patient’s position frequently
- Prevention of deep vein thrombosis
- Therapy focused on patient performance of ADLs
70
disturbed sensory perception: right hemisphere damage
- visual-perceptual or spatial-perceptual tasks (not aware of one side of body): approach and tap from side that she is not aware of to reorient and retrain the brain
- ADLs difficult
- Ambulation: fall risk, bed alarm, scheduled toileting
- Personality changes (impulsivity- laughing/crying/swearing)
71
disturbed sensory perception: left hemisphere damage
- memory deficits
- difficulty with carrying out simple tasks
- speech, language (aphasias)
72
unilateral neglect is most commonly seen with (stroke type)
right cerebral stroke
73
interventions for unilateral neglect
- Observe safety measures* (explain to family)
- Touch and use both sides of the body
- Use scanning technique of turning the head from side to side to expand the visual field
74
impaired verbal communication includes
- language or speech problems
- expressive aphasia, Broca's area (have a hard time finding their words and expressing themself)
- receptive aphasia, Wernicke's or sensory (have a hard time understanding what other people are expressing to them)
75
symptoms of dysphagia (difficulty swallowing)
- difficulty swallowing
- choking or coughing
- weight loss from eating less
- taking a long time to eat
- food left in mouth after swallowing (pocketing)
- frequent chest infection
76
interventions for impaired swallowing
- dysphagia screen (nursing)**
- swallow evaluation (speech-language pathology)
- patient positioning to facilitate the process of swallowing before feeding
- appropriate diet for the patient, including semisoft foods and fluids (thick-it- can manage liquids better with this powder, makes fluids like a honey texture)
- aspiration precautions
77
urinary and bowel incontinence includes
- Altered level of consciousness may cause incontinence or impaired innervation or an inability to communicate.
- Sexual dysfunction
types:
- stress
- urge
- reflex
- overflow
78
interventions for bowel and bladder incontinence
- develop a bladder and bowel training program
- frequent toileting
- stool softeners, laxatives
- urology consult for sexual dysfunction
79
traumatic brain injury (TBI) definition
head injury occurs as a result of blow or jolt to the head or as a result of penetration of the head by a foreign object
- such as a bullet
80
open head injury definition
occurs when there is a skull fracture or when the skull is pierced by a penetrating object
- the integrity of the brain and the dura is violated, and exposure to outside contaminants occurs
- there is a hole in the brain
- infection risk!!
81
closed head injury definition
the result of blunt trauma
- the integrity of the skull is not violated
82
s/sx of a TBI
- amnesia
- seizure *very concerned if pt with TBI has a seizure
- LOC/lethargy
- behavioral changes
- visual
- ataxia
- CHECK THE PUPILS AND GCS
83
basilar skull fracture occurs at the (location)
base of the skull
- break in the skull at base (very thin bone!)
- Usually extends into the anterior, middle, or posterior fossa and results in cerebrospinal fluid leakage from the nose or ears (halo on gauze=CSF)
- huge risk of infection!
84
a basilar skull fracture has the potential for (complications)
- hemorrhage
- damage to cranial nerves
- infection
85
nursing assessment of a basilar skull fracture: expected sx
- Battle’s signs: bruising behind the ears (bruising over the mastoid process)
- raccoon eyes
86
types of closed head injuries
- Mild concussion
- Diffuse axonal injury: all parts of the brain were knocked around and damage, poor neuro sx, CT is clean
- Contusion (coup and contrecoup injury): more areas of brain are affected
- Laceration: hit your head so hard that the vessels in the brain tear
87
concussion: patients who have sustained a minor head injury are more likely to deteriorate if: (what circumstances occur)
- Loss of consciousness lasting more than 5 minutes
- Post-traumatic amnesia
- Persisting neurologic signs or symptoms
- Impaired consciousness
- Skull fracture
- More than one episode of head trauma (ie, the patient is knocked out, recovers, and returns to the game, where he is again traumatized)
88
warning signs of a head injury in the first 24 hours
- changes in LOC**(#1 flag): increased drowsiness, confusion, difficult to arouse
- seizures
- bleeding or water drainage (CSF) from nose or ears
- pupils slow to react or unequal
- visual problems
- loss of sensation in any extremity
- slurred speach
- projectile vomiting out of the blue
89
coup and contrecoup injury
coup: bruise or other damage at site of impact
contrecoup: bruise or other damage at opposite side of impact site
ie. hit dash board and then go back and hit back of seat
90
acceleration-deceleration injury
when head moves suddenly and violently, unrestricted
ie. high speed MVA, whiplash
91
secondary injuries to head injuries
- increased ICP
- hemorrhage: epidural, subdural, intracerebral
- hematoma development, hydrocephalus
- brain herniation
92
epidural hematoma
epi=above, above the dura mater, between skull and dura mater
- Neurologic emergencies with potentially catastrophic ICP elevation
- ARTERIAL BLEEDING into space between the dura and inner table of skull
- Temporal bone fractures, middle meningeal artery
- Momentary unconsciousness follows LUCID INTERVAL within minutes of injury, decline pretty rapidly after that
- often young, sporty person, traumatic injury
- people think they are fine because of the lucid interval so they don't seek medical attention
93
subdural hematoma
sub= under, under the dura mater, between dura mater and arachnoid
- VENOUS BLEEDING into the space beneath dura and above arachnoid
- Most commonly from a tearing of the bridging veins within the cerebral hemispheres or from a laceration of brain tissue
- Bleeding occurs more SLOWLY, and symptoms mirror those of epidural hematoma
- commonly seen in older patients, get hx, commonly associated/confused (?) with alcohol use d/o
94
complications of subdural hematoma
- hydrocephalus
- brain herniation
95
brain herniation definition
- bad thing- ominous sign that there is so much pressure in the brain, its getting squished
- will be seen in CT
- neurologist will talk with pt family regarding organ donation
- most likely pt will not survive this
sx:
- pupil unilateral dilated and nonreactive
- rapidly deteriorating LOC
- seizures/posturing
- VS: cushings triad- decreased HR, RR, increased BP
96
medical management of a head injury (non-surgical)
- ABCs
- Assessment of vital signs to prevent and detect increased ICP **
- Positioning
- Pulmonary ventilation and management of oxygen and carbon dioxide levels
- Suctioning
- Chest physiotherapy and frequent turning
97
medication therapy for head injuries
- steroids: Glucocorticoids
- strong diuretics: Mannitol, furosemide, lasix
- Opioids, naloxone (for comfort, will affect pupils, mental status)
- Neuromuscular blocking agents: propofol if sedated and on vent
- Antiepileptic drugs
- Acetaminophen and aspirin
- Barbiturate coma: phenobarbital (old fashioned)
98
surgical management for head injuries
- ICP monitoring device
- craniotomy may be performed in extreme instances of elevated ICP
99
ICP monitoring devices
- Intraventricular catheter (IVC)
- Subarachnoid screw or bolt (in head)
- Epidural catheter (window to swell out of)
- Subdural catheter (window to swell out of)
100
criteria to declare brain death (*nice to know*)
note: brain death = patient is dead; has to meet certain criteria; 2 neurologists declare; very strict rules
- support family
- advocate for patient and family
nice to know:
- Glasgow coma scale <3 (lowest score possible)
- Apnea (off ventilator don't try to breathe at all)
- No pupillary response (with light shine)
- No cough and gag reflex
- No oculovestibular reflex (squirt cold water into ear, no eye reaction)
- No corneal reflex (touch cornea with gauze, absent corneal reflex
- No oculocephalic reflex (dolls head, eyes flop with head rotation side to side)
101
neuro assessment for stroke (expected sx of stroke)
3 or more 80% risk of stroke
1 of 3 70% risk of stroke
- aphasia (speech)
- ataxia (poor coordination, tripping)
- cranial nerve palsy: assess CN7: scrunch face
- diplopia (double vision)
- dysphagia (swallowing)
- dysarthria
- hemianopia
- hemiparesis
- loss of sensation
- visual field disturbance (cant see one field)
- sudden confusion
- dizziness
- sudden severe HA: typically seen in hemorrhagic
- cincinnati prehospital stroke scale (face-droop, arms- pronating drift, speech- slurred, time- when did it start: 911 or hospital)
102
seizure precautions
- oxygen
- suction equipment**
- airway: turn to side
- IV access**
- side rails up
- protect from environment (dont let pt fall out of bed, environment is not cluttered)
- turn on side
- don't force anything into mouth (no tongue blade!)
103
post-ictal state
right after seizure
- confusion, period of altered consciousness
- then return to normal
104
rescue seizure meds
benzos: "-pams"
rectal valium if not IV access possible
