Chapter 19: Seizures and Syncope

Question 1

seizure

Answer 1

a sudden and temporary alteration in brain function caused by massive, continuing electrical discharges in a group of nerve cells in the brain

Question 2

convulsion

Answer 2

jerky muscle contractions

Question 3

epilepsy

Answer 3

a chronic brain disorder characterized by recurrent unprovoked seizurers

Question 4

generalized tonic-clonic seizure

Answer 4

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

Question 5

primary (unprovoked) seizures

Answer 5

usually due to a genetic or unknown cause, most commonly epilepsy. generalized or partial seizures

Question 6

generalized seizures

Answer 6

involve both brain hemispheres and the reticular activating system, typically results in a loss of consciousness, usually characterized by a jerking muscle activity (convulsions)

Question 7

partial seizures

Answer 7

abnormal activity in just one cerebral hemisphere, either simple (patient remains awake and aware), or complex (patient remains awake but NOT aware)

Question 8

awake state

Answer 8

eyes open, maintains posture and muscle tone, RAS and one cerebral hemisphere must be functioning

Question 9

aware state

Answer 9

patient’s cognition is intact

Question 10

cognition

Answer 10

having perception, attention, emotion, memory, and executive function

Question 11

secondary (provoked) seizures

Answer 11

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

Question 12

status epilepticus

Answer 12

• 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

Question 13

brief seizure

Answer 13

lasts less than 5 minutes

Question 14

prolonged seizure

Answer 14

lasts between 5-30 minutes

Question 15

status epilepticus might lead to following complications

Answer 15

• aspiration
• brain cell damage from hypoxia and lack of glucose
• dehydration
• fractures or dislocations

Question 16

generalized convulsive seizures

Answer 16

• tonic-clonic

Question 17

generalized nonconvulsive seizures

Answer 17

• absence
• myoclonic
• tonic
• atonic

Question 18

signs and symptoms of generalized tonic-clonic seizure

Answer 18

• aura
• loss of consciousness
• tonic phase
• clonic phase
• postictal state

Question 19

generalized tonic-clonic seizure

Answer 19

“grand mal seizure,” begins with abnormal electrical activity low in cerebral cortex that spreads upwards and downwards, affects both cerebral hemispheres and RAS

Question 20

aura

Answer 20

warning that a seizure is going to begin, involves a sensory perception by the patient

Question 21

tonic phase

Answer 21

muscle rigidity, patient’s muscles become contracted and tense, may exhibit hyperextension of back (hypertonic phase), lasts about 30-60 seconds

Question 22

clonic phase

Answer 22

convulsion, muscle spasms alternate with relaxation, lasts 1-2 minutes

Question 23

absence seizure

Answer 23

“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

Question 24

myoclonic seizure

Answer 24

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

Question 25

tonic seizure

Answer 25

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

Question 26

atonic seizure

Answer 26

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

Question 27

febrile seizure

Answer 27

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

Question 28

simple partial seizure

Answer 28

“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

Question 29

motor seizure

Answer 29

patient has jerking/stiffening of one part of body only on one side

Question 30

sensory seizure

Answer 30

patient’s senses affected

Question 31

autonomic seizure

Answer 31

change in the autonomic function of the patient’s body (e.g. strange or unpleasant sensation in stomach, head, or chest)

Question 32

psychic seizure

Answer 32

changes in how the patient thinks, feels, or experiences things

Question 33

emergency medical care for simple partial seizures

Answer 33

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

Question 34

complex partial seizure

Answer 34

“psychomotor or temporal lobe seizure,” usually lasts 30 seconds to 2 minutes, patient remains awake but is unaware

Question 35

secondarily generalized seizure

Answer 35

occur when simple partial or complex partial seizure activity spreads to both sides of brain and involves entire body

Question 36

transport priority circumstances

Answer 36

• 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

Question 37

emergency medical care for seizures

Answer 37

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

Question 38

benzodiazepine

Answer 38

Diastat, the most common medication used to stop generalized tonic-clonic seizures in prehospital setting

Question 39

syncope

Answer 39

fainting, sudden and temporary loss of consciousness due to temporary lack of blood flow to the brain

Question 40

emergency care for presyncope

Answer 40

place patient in supine or seated position, have patient constrict muscles in upper and lower body

Question 41

difference between syncope and seizure activity

Answer 41

• 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