Convulsions (adults) Flashcards
What is a convulsion?
Involuntary contraction and relaxation of the muscles. This produces rigidity and violent shaking of the body and limbs.
Associated with reduced LOC.
Epileptic seizures are caused by
Abnormal electrical activity in the brain. The type of epileptic seizure depends on which part of the brain is affected.
A bilateral tonic clonic seizure:
Symmetric stiffening of the whole body (tonic phase) gradually merging into vigorous shaking (clonic phase).
Typically eyes are open, and the patient is non responsive to sensory stimuli.
A BTCS will usually self terminate after _ seconds:
90
What is convulsive status epilepticus?
A BTCS that has not stopped after 5 minutes
OR
A series of seizures without a recovery of 5 minutes+ between each one.
This is a medical emergency and requires rapid treatment.
PNES can be confused for status epilepticus as they often last over 5 minutes. How can we differentiate?
PNES:
Fluctuates intensity
Brief pauses, slow flexion
Non symmetrical
May respond to some stimuli - i.e. reactive pupils
Rare tongue biting
Eyes mostly shut (resistant to opening)
Mouth often shut
Purposeful movements
Normal SpO2 - nil cyanosis
Arching of head, neck, spine
Rapid end.
Rapid post ictal recovery.
Normal post ictal breathing.
Discuss convulsions relating to alcohol:
Withdrawal and delirium tremens (severe form of withdrawal after approx 3 days: rapid onset of confusion, shaking, shivering, irregular HR, agitation, HTN etc)
is a cause of seizures and requires urgent medical treatment.
Chronic alcohol use predisposes to seizures.
Convulsion treatment for ONGOING or RECURRENT convulsions:
DRcABCDE
A - do not attempt OP with trismus. NP can be a good choice. Inability to tolerate adjuncts is not consisten with BTCS.
B - O2 if required, BTCS can cause hypoxia and cyanosis.
C - HTN. ?Eclampsia in pregnancy. Sinus tachy is expected in BTCS/PNES.
D - Responsiveness during convulsions is likely PNES. MEASURE BM!
Temp, ?infection cause.
E - ?head injury cause. Convulsions may cause injurires.
- Incontinence regularly occurs.
Correct position - safety and comfort, protect from danger, aspiration and head injury.
Duration under 5 minutes - follow individual treatment plan.
Duration over 5 minutes OR 3+ in one hour AND STILL CONVULSING - Status Epilepticus - Follow individualised treatment plan or our algorithm
1st dose of midazolam - IM FIRST
If still convulsing after 10 minutes of 1st dose…
2nd dose of midazolam - THEN IV IF POSSIBLE
If nil response to 2nd dose of midazolam, consider:
Senior clinical support
Alternative diagnoses, PNES?
Reasons for lack of effect. Poor administration, absorption, patient size, correct dose?
Access to alternative anti-convulsants
Risk/benefit of a 3rd dose of benzodiazepine. Side effects+
Prepare for airway obstruction. respiratory depression, hypotension, arrythmias
