Seizure Administrative Guideline

Question 1

History

Answer 1

• Hx of seizure disorder
• Seizure medications
• Alcohol withdrawal
• Hx Trauma
• Hx Diabetes
• Hx Pregnancy
• Overdose
• History of Isoniazid use

Question 2

Signs and symptoms

Answer 2

- Decreased mental status compared
to baseline
- Signs of trauma
- Witnessed seizure activity
- Urinary incontinence

Question 3

Differential

Answer 3

• Trauma
• Alcohol withdrawal
• Metabolic/electrolyte abnormality (i.e.
  renal failure)
• Stroke
• Hypoglycemia
• Infection/Feve

Question 4

Actively seizing NO?

Answer 4

ALS/BLS General AG
Consider Altered/Neuro/ Overdose AG if indicated

Then reassess and monitor VS

Question 5

Actively seizing YES?

Answer 5

Consider OB/GYN AG if gestational age >20 weeks or 6 weeks postpartum

Administer benzodiazepines.
If age >60, consider reducing dose by half
Midazolam 0.2 mg/kg IM
Max 5mg if <40kg
Max 10mg if ?40kg
if seizure onset afer IV established, administer
Midazolam 0.1 mg/kg IV
Max single dose 5 mg
Administer slowly ? Over 2 minutes

Oh yeah, and do the normal ALS stuff like IV access, O2, cardiac monitor, EtCO2, FSBG

Question 6

Actively seizing STILL YES?

Answer 6

May repeat benzodiazepine for continued seizure
Repeat IM dosing above
or
Midazolam 0.1 mg/kg IV
Max single dose 5 mg
Administer slowly ? Over 2 minutes

Reassess and monitor VS

Question 7

Status epileticus

Answer 7

Status epilepticus occurs when a seizure lasts longer than 5 minutes or when seizures occur close together without a patient regaining normal mental status between seizures

Question 8

Generalized

Answer 8

This seizure affects the whole brain at once. They begin with stiffening of the limbs (the tonic phase), followed by rhythmic jerking of the limbs and face (the clonic phase). A generalized seizure is the type most likely to be encountered by EMS responders. A generalized tonic-clonic seizure can also be caused by head trauma, poisoning, brain tumors, metabolic disorders or other acute conditions affecting the brain

Question 9

Focal

Answer 9

Seizure activity is limited to a part of one brain hemisphere. There is a site, or a focus, in the brain where the seizure begins. Patients may or may not be aware of their surroundings depending on the type of focal seizure. Symptoms may be confined to one extremity or portion of a patient’s body.

Question 10

Febrile

Answer 10

Febrile seizures occur in children from 6 months to 5 years of age. A febrile seizure must be a generalized seizure in the setting of fever, lasting less than 5 minutes, and with return to normal neurologic baseline. Treat the seizure if lasting > 5 minutes.

Question 11

Eclamptic

Answer 11

Eclampsia is an obstetric emergency. It is considered a complication of severe preeclampsia, and is commonly defined as new onset of grand mal seizure activity and/or unexplained coma during pregnancy or the postpartum period in a woman with signs or symptoms of preeclampsia. Eclampsia typically occurs during or after the 20th week of gestation or in the postpartum period.

Question 12

What medications can cause seizures?

Answer 12

anti-depressants (e.g. escitalopram, citalopram, bupropion), anti-cholinergics (e.g. diphenhydramine), illicit drugs (e.g. cocaine), and antibiotics (e.g. Isoniazid).

Question 13

What about seizure refusals?

Answer 13

Patients with first time or new-onset seizures should be strongly encouraged to accept transport to
the ED since there are multiple life-threatening conditions that may be present. If refusing transport, these
patients should be made aware of the potential for underlying medical conditions.
- Refer to Refusal AG