Seizures

Question 1

when should midazolam be administer

Answer 1

Administer midazolam if the seizure is generalized and continues for longer than five minutes, or the patient has status epilepticus

Question 1

IV midazolam dosage

Answer 1

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.

Question 2

IM Midazolam dosage

Answer 2

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

Question 3

what to do if the patient has their own anti convulsant medications

Answer 3

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.

Question 4

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:

Answer 4

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

Question 5

define status ecliptics

Answer 5

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.

Question 6

impact of seizing on the brain

Answer 6

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.

Question 7

how to draw up IV midaz

Answer 7

1. draw up 12 mls saline
2. draw up 3 mls midaz
3. left with 1mg/1ml admin 5mg

Question 8

following the seizure you should…

Answer 8

• Position the patient on their side.
• Maintain airway and breathing.
• Monitor pulse oximetry and administer oxygen if required.

Question 9

seizure classification

Answer 9

generalised (grand mal) or partial (focal or localised).

Question 10

partial seizures may be

Answer 10

simple (where the patient retains awareness of their surroundings) or complex (where the patient loses awareness of their surroundings).

Question 11

A patient having partial seizures may present

Answer 11

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.

Question 12

how to draw up midaz for a pead

Answer 12

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.

Question 13

midazolam mechanism

Answer 13

• Midazolam is a benzodiazepine.
• Midazolam enhances the activity of gamma-aminobutyric acid (GABA) at GABA receptors within the central nervous system, resulting in anticonvulsant activity, sedation, amnesia, ant axiety and muscle relaxation.

Question 14

midazolam common adverse affects

Answer 14

Common adverse effects
* Sedation.
* Respiratory depression.
* Hypotension.
* Amnesia.

Question 15

IV midaz onset

Answer 15

• IV: 2-3 minutes.

Question 16

IM midaz onset

Answer 16

3-5 mins

Question 17

duration of midaz

Answer 17

30-60

Question 18

if seizures persists post 2 doses of midaz…..

Answer 18

Administer levetiracetam IV if the seizure continues or recurs after two parenteral doses of midazolam:
2 g of levetiracetam for an adult.
See the paediatric drug dose tables for a child.
Repeat once after ten minutes for an adult, if the seizure continues or recurs ten minutes after the first dose.
Consider performing RSI if the seizure continues.

Question 19

why is seizing a life threatening condition

Answer 19

ū Status epilepticus is life-threatening because it is commonly associated with hypoxia, hypercarbia, metabolic acidosis (lactate is produced during vigorous skeletal muscle activity), hyperthermia (as a result of prolonged muscle activity) and aspiration.
ū RSI may be required.
ū General anaesthesia and admission to an intensive care unit is often
required.

Question 20

pregnancy and seizure treatment

Answer 20

If the patient is more than 20 weeks pregnant and eclampsia is suspected, administer 20 mmol (4.94 g) of magnesium IV over approximately 15 minutes, in addition to treatment within this section.

Question 21

Levetiracetam mechanism

Answer 21

Levetiracetam is an anticonvulsant. It is thought to inhibit seizure activity by blocking some calcium channels and also binding synaptic proteins to modulate neurotransmitter release.

Question 22

Levetiracetam indication

Answer 22

Seizure that continues or recurs after two doses of parenteral midazolam.

Question 23

Levetiracetam contras

Answer 23

allergy

Question 24

Levetiracetam cautions

Answer 24

nil

Question 25

Levetiracetam dosage

Answer 25

2g IV (20mls) diluted with 20-40 mls of saline

Question 26

Levetiracetam onset

Answer 26

10mins

Question 27

Levetiracetam duration

Answer 27

6-8 h

Question 28

outline the 3 steps of midazolam’s mechanism

Answer 28

1. GABA binds to a receptor under the influence by midaz
2. receptors response more prominent, thus more chloride flows into the cell
3. cells much less likely to fire, thus reduces dysregulated firing

Question 29

when a person is seeing there is a decrease in….

Answer 29

GABA neurotransmitters in the brain

Question 30

when GABA binds to the receptor….

Answer 30

the receptor has a benzodiazepine attached, thus the receptors response is likely to be more prominent, leading to more chloride in the cell which results in it being less likely to fire

Question 31

the disregulated signals in the brain are caused by

Answer 31

action poteintal depolarising in a disorganised fashion

Question 32

what is the normal function of GABA in the brain

Answer 32

Gamma-aminobutyric acid (GABA) is the most common inhibitory neurotransmitter in your central nervous system. GABA lessens the ability of a nerve cell to receive, create or send chemical messages to other nerve cells.