Seizure Flashcards
How can we recognise a tonic-clonic seizure?
- Erratic muscular movement, grunting noises.
- Pts usually known to have generalised seizures.
- Risk factors for provoked seizures identified e.g. hypoglycaemia.
- Patient will become unconscious
- Movement: profound muscle stiffness followed by widespread dis-coordinated muscle movement. Tongue biting & incontinence may occur.
Describe the ABCDE assessment for a seizure.
Airway:
Symptoms: audible sounds – grunts, snoring, gurgles. Visual inspection upon seizure termination may show ST injury.
Breathing:
Symptoms:
- Hypoxia may provoke seizure activity
- Unlikely to achieve a valid O2 saturation or RR whilst seizure activity high
- Signs of cyanosis
Circulation:
Symptoms:
- Unlikely to achieve a valid HR or cap refill time whilst seizure activity high
Disability:
Symptoms:
- Low capillary blood glucose may provoke seizure
- Unconscious during seizure
- AVPU score may vary during post-ictal phase
- Pain from any injury sustained
Exposure:
Symptoms: possible injury
What is the management of a tonic-clonic seizure?
- Safety – lower dental chair. Where possible, remove items/obstacles which may cause injury.
- Position – airway management may be difficult when teeth are clamped. Lay pt flat & encourage a head-tilt, chin lift position. Do not brace or hold in position. Once seizure terminated, place pt in recovery position.
- O2 – administer 15L/min via non-rebreather mask.
- check for a seizure care plan
- Note the time :
- If seizure ends <5 mins & no injury -> support & monitor through post-ictal phase.
- If seizure ends >5 mins in pt with known, prolonged or serial seziures -> follow care plan. If absent, give 10mg Midazolam. Call 999.
Call 999 if: first seizure, if seizure lasts <5 mins but reoccurs 3x in 1 hr.
If seizure ends >5 mins in pt not known to have prolonged seizures.
- ABCDE assessment - check capillary blood glucose
- If not abnormalities plan for safe discharge & consider care plan if present.
OR
Treat abnormal ABCDE findings & continue to monitor. - Complete incident report.
Describe seizure activity
- Seizures are disorganised or abnormal electrical activity in the cerebral cortex
Partial seizures: focussed erratic movements.
Tonic clonic seizure: widespread erratic movement, grunting, incontinence, frothing, tongue biting. Usually last 2-3 mins.
What is the STOPP management steps?
Safety Time Oxygen Prolonged Plan
- Safety - remove objects from mouth (use tweezers if possible), clear environment, supine position & support pts head, monitor airway.
- Time - record start & end time. Check for alert card, care plan or medical alert bracelets.
- O2 - 15L/min of oxygen via a non-rebreather mask. Leave in situ for duration of seizure.
- Prolonged - seizures >5 mins or 3 repeat seizures in an hour indicate status epilepticus. ALWAYS call 999 unless care plan indicates otherwise.
-> ** In practice only: administer Midazolam in pts with a h/o prolonged or serial seizures.
Dose: Adult & child >10 yrs 10 miligrams (1ml) - Plan - call a friend for discharge (unless ambulance indicated). Consider dignity on discharge in incidence of incontinence.
Which medical emergencies can trigger a seizure?
Hypoglycaemia and hypoxia may be a cause for seizure activity, assess and rule out reversible causes.
What are the side effects of Midazolam?
Midazolam is associated with drowsiness and respiratory depression
*only administered in practice not LDI
What are the doses for children aged 2-4 and children aged 5-9 for Midazolam?
*only administered in practice not LDI
Children aged 2-4: 5 miligrams (0.5ml)
Children aged 5-9: 7.5 miligrams (0.75ml)
Summarise when you need to call 999
- Prolonged or serial seizures
- First seizure
- Injury sustained requiring ambulance
- When midazolam indicated (*only administered in practice not LDI)
How does midazolam work?
Reduces nerve cell firing in brain and muscles.
This reduces the seizure activity and shaking.
BUT it can also result in:
1. low respiratory rate
2. hypoxia
3. low heart rate
4. low pressure
Seizure management : TONIC PHASE (beginning of seizure)
- Lay patient flat
- Remove extraneous items
- Protect patient’s head
- Note and record time of seizure
Seizure management : CLONIC PHASE (during seizure)
- Apply Oxygen via non rebreather - 15L
- Stay beside pt during seizure
- Ask colleagues to support pt whilst in dental chair
- Is pt safe on dental chair? Move pt only if its the safest option for everyone involved.
Seizure management : POST ICTAL PHASE (end of seizure)
- Place pt in recovery position
- Stay with the patient
- Remove oxygen as pt starts to come round
- Perform ABCDE assessment and rule out any reversible causes (hypoxia/ hypos)
What other differential causes do we need to rule out when suspecting seizures?
Syncope
Hypos
How to differentiate between seizures and syncope?
Shared characteristics:
Loss of postural tone
Loss of consciousness
Seizures:
Typically lasts 2-3 minutes
Erratic muscle activity
Frothing at the mouth
Head turning to one side
Tongue biting
Incontinence
Post-ictal phase
Syncope:
Typically lasts 20-30 seconds
Typically complete and spontaneous recovery
