seizures Flashcards
key vital to take in seizure patients
BGL
when should midazolam be administer
Administer midazolam if the seizure is generalised and continues for longer than five minutes, or the patient has status epilepticus.
IV midazolam
Administer midazolam IV:
a) 5 mg of midazolam IV for an adult. Reduce the dose to 3 mg if the patient is frail.
b) See the paediatric drug dose tables for a child.
c) This may be repeated once after five minutes.
IM Midazolam
a) 10 mg of midazolam IM for an adult. Reduce the dose to 5 mg if the patient is frail.
b) See the paediatric drug dose tables for a child.
c) This may be repeated once after ten minutes
what to do if patient has own medication to stop seeing
Some patients have pre-prescribed medicines to be administered via the rectal, nasal or buccal route. All personnel may administer such medicines, even if not within their delegated scope of practice, provided they have been prescribed for that patient and the seizure continues for longer than five minutes, or the patient has status epilepticus.
The patient may receive a clear recommendation not to be transported to a medical facility by ambulance, even if midazolam has been administered, provided the patient:
a) Has known epilepsy with no significant change in their usual pattern
seizures, or has recreational drug poisoning, and
Has not been injured, and
Has recovered to a safe postictal state, and
Can be left in the care of a competent adult,
and
Has received a maximum of one dose of parenteral midazolam by ambulance personnel,
and
Is instructed to see their GP within 72 hours for a review of their treatment
definition of status elepticus
ū Seizures that persist despite two doses of parenteral midazolam from clinical personnel, or
ū Three or more seizures with failure of the patient to have normal or purposeful movement between seizures.
impact on the brain of of status elepticus
ū Prolonged and uncontrolled seizures alter brain receptor activity, making pharmacological control of seizures more difficult. The longer the seizures persist before being controlled, the more difficult control becomes.
following the seizure you should…
- Position the patient on their side.
- Maintain airway and breathing.
- Monitor pulse oximetry and administer oxygen if required.
seizure classification
generalised (grand mal) or partial (focal or localised).
Partial seizures may be….
simple (where the patient retains awareness of their surroundings) or complex (where the patient loses awareness of their surroundings).
Partial seizures may be….
simple (where the patient retains awareness of their surroundings) or complex (where the patient loses awareness of their surroundings).
A patient having partial seizures may present
without obvious convulsions or motor activity and may be able to obey commands and interact during seizure activity. The patient may present with any combination of the following:
ū Habitual repetitive movements (automatisms).
ū Sensory symptoms including visual or auditory hallucinations.
ū Emotional outbursts or unusual feelings, such as feeling like they are
outside their body.
ū Blank gaze.
Non-epileptic seizures occur when there
is motor activity that looks clinically like seizures, but there is no electroencephalography (EEG) evidence of seizure activity in the brain.
how to draw up midazolam for a Pead
Midazolam IV 1 mg/ml
* Draw up 1 ml of midazolam from a 15 mg/3 ml ampoule.
* Dilute to a total volume of 5 ml using 0.9% sodium chloride.
* Discard unrequired drug and administer the volume from the tables as an IV bolus.
