Chapter 19: Seizures and Syncope Flashcards
seizure
a sudden and temporary alteration in brain function caused by massive, continuing electrical discharges in a group of nerve cells in the brain
convulsion
jerky muscle contractions
epilepsy
a chronic brain disorder characterized by recurrent unprovoked seizurers
generalized tonic-clonic seizure
most common type of epileptic seizure, aka grand mal seizure, rarely last more than a few minutes, postictal state follows seizure (recovery period): weak, sleepy, unresponsive, disoriented, etc
primary (unprovoked) seizures
usually due to a genetic or unknown cause, most commonly epilepsy. generalized or partial seizures
generalized seizures
involve both brain hemispheres and the reticular activating system, typically results in a loss of consciousness, usually characterized by a jerking muscle activity (convulsions)
partial seizures
abnormal activity in just one cerebral hemisphere, either simple (patient remains awake and aware), or complex (patient remains awake but NOT aware)
awake state
eyes open, maintains posture and muscle tone, RAS and one cerebral hemisphere must be functioning
aware state
patient’s cognition is intact
cognition
having perception, attention, emotion, memory, and executive function
secondary (provoked) seizures
aka retractive or symptomatic seizures, do not result from a genetic cause, occur as a result of an insult to the body (fever, infection hypoxia, etc…), typically generalized in nature, less likely to produce partial-type seizures, need to ID and treat the underlying cause of the seizure activity, can result in death if not treated promptly
status epilepticus
- a continuous seizure activity lasting longer than 30 minutes
- two or more sequential seizures without a full recovery of consciousness between seizures
- this usually results in permanent brain cell injury, presents 3 ways:
1) generalized convulsive status epilepticus with a persistent postictal depressed mental status between seizures
2) nonconvulsive seizures that produce a continuous or fluctuating “epileptic twilight” state
3) repeated partial seizures with focal motor signs, focal sensory deficits, or focal impaired function not associated with an altered awareness
brief seizure
lasts less than 5 minutes
prolonged seizure
lasts between 5-30 minutes
status epilepticus might lead to following complications
- aspiration
- brain cell damage from hypoxia and lack of glucose
- dehydration
- fractures or dislocations
generalized convulsive seizures
- tonic-clonic
generalized nonconvulsive seizures
- absence
- myoclonic
- tonic
- atonic
signs and symptoms of generalized tonic-clonic seizure
- aura
- loss of consciousness
- tonic phase
- clonic phase
- postictal state
generalized tonic-clonic seizure
“grand mal seizure,” begins with abnormal electrical activity low in cerebral cortex that spreads upwards and downwards, affects both cerebral hemispheres and RAS
aura
warning that a seizure is going to begin, involves a sensory perception by the patient
tonic phase
muscle rigidity, patient’s muscles become contracted and tense, may exhibit hyperextension of back (hypertonic phase), lasts about 30-60 seconds
clonic phase
convulsion, muscle spasms alternate with relaxation, lasts 1-2 minutes
absence seizure
“petit mal seizure,” most common in children, no convulsive activity, sudden cessation of conscious activity - lack of speaking and blank stare, lasts 5-15 seconds, no emergency care needed unless it lasts longer than 5 minutes
myoclonic seizure
sporadic brief jerks of muscle groups on both sides of the body, often occur during sleep or when the patient is just falling asleep, no emergency care needed unless it lasts longer than 30 minutes
tonic seizure
sudden onset of greatly increased muscle tone in body, arms, legs, causing sudden muscle rigidity, occurs mostly during sleep, usually lasts 20-30 seconds, no emergency care needed unless it lasts longer than 5 minutes
atonic seizure
total loss of muscle tone resulting in loss of muscle strength, “drop attacks/drop seizures,” patient stays conscious and recovers almost immediately, lasts only 15 seconds, greatest danger is trauma from fall, no emergency care necessary unless it lasts longer than 5 minutes
febrile seizure
a seizure associated with a high fever without any evidence of intracranial infection or other definite cause of seizure, most common in children, often short, always assume they are serious
simple partial seizure
“focal motor or jacksonian motor seizure,” patient is awake and aware that seizure activity is occurring, retains cognition, 4 types:
1) motor seizure
2) sensory seizure
3) autonomic seizure
4) psychic seizure
motor seizure
patient has jerking/stiffening of one part of body only on one side
sensory seizure
patient’s senses affected
autonomic seizure
change in the autonomic function of the patient’s body (e.g. strange or unpleasant sensation in stomach, head, or chest)
psychic seizure
changes in how the patient thinks, feels, or experiences things
emergency medical care for simple partial seizures
may not be necessary if it is reoccurring or seizure does not last longer than 5 minutes, if for the first time, patient must be transported for medical evaluation
complex partial seizure
“psychomotor or temporal lobe seizure,” usually lasts 30 seconds to 2 minutes, patient remains awake but is unaware
secondarily generalized seizure
occur when simple partial or complex partial seizure activity spreads to both sides of brain and involves entire body
transport priority circumstances
- patient remains unresponsive following seizure
- one of ABCs is inadequate following seizure
- second generalized tonic-clonic seizure occurs without a period of responsiveness between the seizure episodes
- patient is pregnant, has diabetes history, or is injured
- seizure occurred in water
- evidence of head trauma leading to seizure
- no history of epilepsy or other seizure disorder
- seizure is result of drug or alcohol withdrawal or toxin exposure
emergency medical care for seizures
1) prevent injury to patient
2) position the patient (lateral recumbent unless spinal injury suspected or needs ventilation)
3) maintain patent airway (NPA is airway of choice
4) suction
5) assist ventilation if necessary
6) maintain adequate oxygenation
7) transport
benzodiazepine
Diastat, the most common medication used to stop generalized tonic-clonic seizures in prehospital setting
syncope
fainting, sudden and temporary loss of consciousness due to temporary lack of blood flow to the brain
emergency care for presyncope
place patient in supine or seated position, have patient constrict muscles in upper and lower body
difference between syncope and seizure activity
- episode usually begins in a standing position
- patient begins to feel faint or light-headed
- patient becomes responsive almost immediately after becoming supine
- skin is usually pale and moist
