Seizures Flashcards
Causes of Seizures
- Hypoglycaemia
- Hypoxia
- Drug overdose
- Alcohol withdrawal
- Brain damage; stroke, head injury, infection
- Brain tumours
- Problems with the brains development in the womb (epilepsy)
- Psychogenic in cause
- Eclamptic seizures
What is Epilepsy?
A neurological conditions which causes a person to have seizures where the electrical impulses in the brain become disrupted from their normal activity
Types of Seizures
Focal:
- Focal Aware
- Focal Impaired
Generalised:
- Absecne
- Tonic Clonic
- The rest
Focal Aware (Simple Partial)
- One side of the brain is affected.
- Pt doesn’t have any confusion, is aware of surroundings
- Symptoms vary but can include; flashing lights, nausea, abnormal sensation/shaking to one part of the body
Focal Impaired Seizure
- Effect a larger part of the brain compared to focal aware
- Consciousness will be affected; may be confused, may hear you but not understand
- Can be post-ictal afterwards
Absence Seizures
- Both sides of the brain are effected
- Pt has no awareness and will seem to have’ switched off’ and will be unresponsive for 10 to 30 seconds
- Unless had a large cluster, pt unlikely to have post-ictal symptoms
Tonic Clonic
- Affects both sides of the brain or can spread from one side to the other
- Most commonly recognised seizure pattern
- Tonic - stiffness/rigidity
- Clonic - jerking movements
- Usually lasts between 1-3 mins
Conditions in Which an Impulse Causes a Seizure
- Each neurones must be excited
- They must connect to many other neurones within a few synapses
- The message must also be large enough to cause other neurones to act the same way
- Under these conditions, the message spreads very quickly causing disrupted activity. It can effect a part of the brain (partial seizure) or spread to affect the whole brain
Potential Causes to do with Neurones, Synapses and NT’s
- If neurones become damaged, this can change how they send signals
- If there are too little or too many NT’s, this affects how the neurones communicate, causing seizures
- Some neurones have slower than normal ion channels, meaning messages are not ‘turned off’ as quickly as they should be
- Some neurones have different synaptic receptors that receive the NT’s, making it difficult for neurones to ‘turn off’, so the neurone continues to send messages even after its not needed
What’s Happening During a Seizure
- Electrical impulses are disrupted or too many are sent at once
- Neurones can sometimes send out an ‘abnormal’ message. This can then cause a larger than normal depolarisation. AAR making other neurones continuing to send out abnormal messages
Signs and Symptoms; Aura
- Abnormal sensation eg particular smell/taste
- Nausea
- Anxiety
- Vertigo
Signs and Symptoms; Tonic Stage
- LOC, may fall
- Strong tonic spasm can force air out the lungs resulting in a cry or moan
- Saliva/Foam from the mouth
- Blood from biting tongue
- Chest stiffness - may impair breathing
- Gasping or gurgling sounds
- Trismus to the jaw/face
Signs and Symptoms; Clonic Stage
- Jerking movements to the face, arms and legs
- After jerking stops and the body relaxes patients may lose control of their bowel and bladder
Signs and Symptoms; Post-Ictal Stage
- Can be unconscious for up to several minutes while the brain recovers
- Confusion
- Exhaustion
- Memory loss
- Abnormal/combative behaviour if hypoxic/hypercapnic
Signs and Symptoms for Psychogenic Cause
- Jerking that fluctuating in intensity and location
- Brief pauses, slower movements
- Arms/legs are not synchronised
- Some level of responsiveness eg speech, blinking, pain to IV/NPA
- Tongue biting very rare or very minor
- Eyes mostly shut/resist opening
- Mouth often shut
- May carry out purposeful movements
- Normal sats and ?hyperventilation
- Pelvic thrusting common
- Crying during/after convulsion
- Normal plantar response
- Rapid/no post ictal recovery
- Anti-epileptic medications will have no effect
Potential Primary Survey Seizures
Danger - public?
Response - AVPU (if convulsing will be U and if post ictal may be confused)
Airway - see if patent, may see trismus of face and jaw making it difficult to assess airway, blood if bit tongue
Breathing - seizure can cause apnea which can reduce sats. In addition, airway can get covered or obstructed leading to suffocation
Circulation - can have cyanosis, arrythmias, ictal bradycardia, prolonged asystole caused by epileptic and reperfusion of the heart
Disability - rule out hypo as cause, formal GCS, pupils for potential head bleed
Exposure - do temp - ?infection, meningitis. Look for head injury evidence
Secondary Survey Seizures; PMH, SH, DHx
- Important to establish how long the seizure lasted
PMH:
- Any history or markers for infection? look for meningitis red flags
- Epilepsy?
- Diagnosis of brain tumour?
SH:
- Alcohol dependant?
- Take recreational drugs?
DHx:
- Do they take any epilepsy medications? eg pregabalin
- Do they take strong MH medications? (Psychogenic)
Airway Management in Seizures
- Suction as needed
- OPs might be good for maintaining airway patency but use NP is significant trismus
- Deliver oxygen as needed
- Monitor capnography
- Get ready to support ventilations after benzo administration
Other Management in Seizures
- ECG could be indicated to determine if cardiac syncope as cause (may see 20 seconds of jerking/stiffness)
- Look out for post-ictal reperfusion arrythmias (rare)
- Rule out hypoglycaemia as cause as early as possible with BM
- Note injuries caused by seizure activity eg tongue and other trauma
JRCALC Guidelines in Seizures
- ABCDE Approach
- Decide whether psychogenic or not
- If seizure has lasted over 5 minutes/3 or more in an hour administer first benzo (this could be patients own)
- Reassess while gaining access if haven’t already
- Administer 2nd dose, 10 minutes after of what available
- Reassess, if continuing to seize, consider extraction/enhanced care teams/call CCD
Midazolam (CCPs)
CCPs have this drug, a short acting benzo usually given in seizure patients
Differential Diagnosis List for Seizures
- Hypoglycaemia
- Drug Overdose
- Psycogenic
- Syncope
Syncope Seizure Differential
- The most common cause for transient LOC
- Caused by temporal disruption to the oxygen supply to the brain
- Brief but vigorous jerking may occur which will mimic a seizure but stop within 20 seconds once normal circulation is restored
- Recovery is rapid
