Seizures

Question 1

What can cause airway compromise in seizures?

Answer 1

Depressed level of consciousness

Secretions, blood, vomit

Question 2

If the airway is compromised what interventions may be needed?

Answer 2

Head tilt, chin lift
Jaw thrust
Oropharyngeal airway
Nasopharyngeal airway
Call anaesthetics help if obstruction

Question 3

What does tachypnoea indicate in a patient having a seizure?

Answer 3

Suggests significant respiratory compromise

Question 4

If a patient is hypoxic yet has a normal or falling respiratory rate, what does this indicate?

Answer 4

Impending respiratory failure

Question 5

If a patient having a seizure is hypertensive what diagnoses should be considered?

Answer 5

Haemorrhage
Stoke
Eclampsia

Question 6

What bloods should be taken for a patient having a seizure?

Answer 6

FBC/U&E/calcium/magnesium
Glucose
CRP
Coag
Toxicology
Anticonvulsant drug levels
BC

Question 7

When should intervention be started in an adult having a seizure.

Answer 7

During C of ABCDE

After 5 mins if known epileptic

Question 8

What is the first line management for seizures?

Answer 8

Benzodiazepines
Lorazepam IV (4mg bolus)
Midazolam 10mg buccally
Diazepam 10mg PR

Question 9

After how long can the dose of benzodiazepines be repeated?

Answer 9

5mins if no previous dose in past 12hours

Question 10

What other management can be started within 30mins of seizure onset?

Answer 10

Phenytoin 18mg/kg IV at 50mg/min with ECG monitoring or

Sodium valproate 20-30mg/kg IV at 40mg/min if ECG monitoring or phenytoin is not available

Question 11

If there is a history of alcohol abuse or poor nutrition what diagnosis should be considered?

Answer 11

Wernicke’s encephalopathy

Question 12

If there is a history of alcohol abuse or poor nutrition what treatments should be considered?

Answer 12

IV pabrinex

Glucose (50ml of 50%)

Question 13

What differentials should be considered for the seizures?

Answer 13

Epilepsy
Sepsis
Wernicke’s encephalopathy
Drug/medication overdose