Seizure

Question 1

Seizure what is it

Answer 1

Sudden urge in electrical activity in the brain which can change behaviour, movement and levels of consciousness kill.

Can be experienced by anyone, may be an isolated experience

Question 2

Epilepsy - what is it

Answer 2

Chronic seizures

Question 3

Non - epileptic psychogenic seizure

Answer 3

Looks like a seizure

Not caused by electrical activity in the brain

Psychogenic in origin

Question 4

What causes a seizure

Answer 4

Unknown causes
Genetics
Structural changes
Structural abnormalities
Autism
Provoked seizures - hypoglycaemia / hypoxia

Question 5

Focal seizures

Answer 5

Occurs when seizure activity is limited to one part of a single brain hemisphere

Can be grouped according to whether awareness is retained or lost during seizure activity

Question 6

Generalised seizures

Answer 6

Widespread seizure activity in both brain hemispheres

Numerous types of generalised seizure

The most common generalised seizure is a tonic-clonic seizure

Question 7

Stages of tonic - clinic seizure

Answer 7

1. Warning (prodrome) brief - hrs
   - irritable / hallucinations
2. Stiff (Tonic) 1min
   - muscles become rigid inc respiratory muscles = apnoea / grunting noises may occur as air is forced from the lungs
3. Shaking (clonic) 1-3mins
   - widespread discoordinated muscle movement / incontinence
4. Drowsy (Post-ictal) mins-24hrs
   - drowsiness / confusion following termination of seizure activity

Question 8

Recognising a tonic-clonic seizure

Answer 8

The patient
- known to have generalised seizures
- risk factors for provoked seizures identified eg hypoglycaemia

Consciousness
- pt will become unconscious

Movement
- profound muscle stiffness
- widespread discoordinated muscle movement
- tongue biting and incontinence

Question 9

ABCDE assessment seizure

Answer 9

Airway: audible sounds (grunts / snoring / gurgles)
Breathing: hypoxia may provoke seizure activity
Unlikely to achieve a valid oxygen saturation / respiratory rate whilst seizure activity is high
Signs of cyanosis
Circulation: unlikely to achieve a valid heart rate / capillary refill time whilst seizure activity is high
Disability: low capillary blood glucose may provoke seizure
Unconscious during seizure
AVPU score may vary during post ictal phase
Pain from any injury sustained
Exposure: possible injury

Question 10

Management of tonic-clonic seizures

Answer 10

1. Safety - lower dental chair / remove obstacles
2. Position -
   - airway management may be difficult if teeth clamped
   - Lay pt flat and encourage chin lift position
   - Do not brace / hold in position
   - Once seizure terminated place in recovery position

Oxygen - administer 15litres per minute via a non rebreather mask

Time - call 999 if
- first time pt has seizure
- seizure lasted >5mins
- pt has 3 or more seizures in 1 hour

Midazolam
- for prolonged / serial seizures
- individualised care plans should be followed for pt who have them