Seizure management

Question 1

ABCDE management

Answer 1

Recovery position
Maintain airway with jaw thrust
Consider nasopharyngeal airway if airway concern
15L oxygen via non-rebreather mask
Secure IV access
Attach monitoring (pulse oximetry, BP, cardiac monitor)

Question 2

Pharmacological management

Answer 2

If seizure ongoing, within:
10 mins: 4mg lorazepam IV or 10mg diazepam PR
20mins: repeat above
30 mins: phenytoin 18/mg/kg IV
60 mins: general anaesthesia in intensive care unit

50mL 50% glucose IV if any suggestion of hypoglycaemia
Pabrinex 2 pairs IV if any suggestion of alcohol abuse

Question 3

After pt has recovered consciousness

Answer 3

Post-ictal period may last a few hours
Full hx, multi-system examination, complete outstanding investigation (BM, venous gas and venous bloods, ECG….)
Tx cause
Refere to medics / neurology or seizure clinic
Give driving advice and DVLA instructions