M9 - Seizures

Question 1

A seizure (or fit) is a period of ____ ____ ____. The most common presentations encountered are ____ or _____ seizures. Seizures may occur _____ in people with ____ or may occur as a result of ____, ____, ____ ____, ____ ____ and ____ ____ or ____ ____. ____ ____ patients should be provided with the opportunity to _____ on scene. Many ____ ____ patients will regain full ____ ____ within a _____ time frame.

Answer 1

Involuntary muscle contraction.
Partial, generalised
Spontaneously, epilepsy, infection, pyre is, head injury, cerebral tumours, drug overdose, electrolyte imbalance
Post ictal, recover
Post ictal, cognitive function, reasonable

Question 2

Treatment:

1. ____ ____ (__)
2. Protect the patient from ____
3. Administer medications if indicated: ____ (___), indication?
4. Treat associated conditions (if indicated): x3
5. _____ ____ (__) for patients with ____ or _____ seizures
6. Regularly ____ and _____ ABCD physical examinations and _____ _____ in order to identify ____ in clinical deterioration

Answer 2

1. Patient care (A2)
2. Injury
3. Midazolam (219); Seizure >=5minutes
4. Hypoglycaemia (M21); Hyperthermia (E3); Traumatic injuries
5. Urgent transport (A8); recurrent, continuous
6. Repeat, document, physiological observations, trends.

Question 3

Medication for Seizure >=16yo
Medication
Route, dose, repeat, max

Answer 3

Midazolam

IV: Diluted with 4mL NaCl to make 5mg:5mL.
Dose: 2.5mg slow bolus.
Repeat: 3 minutes.
Max: 15mg.

IM:Undiluted.
Dose: 5mg bolus
Repeat: 5 minutes
Max: 15mg

Question 4

Medication for Seizure <16yo
Medication
Route, dose, repeat, max

Answer 4

Midazolam

IN bolus via MAD
Dose: 0.3mg/kg
Max bolus: 5mg
Repeats: None.
Max: 0.3mg/kg

IM bolus
Dose: 0.15mg/kg bolus
Max bolus: 5mg
Repeat: 5 minutes
Max: 0.45mg/kg total

IV diluted with 4mL NaCl to make 5mg:5mL
Dose: 0.15mg/kg bolus
Max bolus: 2.5mg
Repeat: 3 minutes
Max: 0.45mg/kg total.

Total max is inclusive of all routes. Paediatric patients can have 1x IN dose followed by 1x IM/IV to max of 0.45mg/kg.

Question 5

Protocol Specific Exclusions (12)

Answer 5

• Alone/no carer
• Concurrent acute illness
• First seizure presentation
• History of multi-seizure presentations
• History of recent traumatic brain injury
• Seizure type/pattern differing to usual presentation
• Suspicion of overdose/aspiration
• Intoxication
• Unwitnessed seizure
• Pregnancy
• Increased frequency of seizures
• Seizure involving submersion