Seizure Managmenet Flashcards
(16 cards)
Seizure ABCDE protocol?
Ensure to check O2 sats
Ensure to check finger prick glucose
Place in recovery position if possible
O2 saturation is crucial for assessing respiratory function during a seizure.
What are some underlying aetiologies to consider when taking a focused history for seizures?
- Headache (may indicate Subarachnoid hemorrhage)
- Falls or head injury
- Abnormal movements of face or limbs
What are some pre-seizure symptoms to note?
- Sensory aura
- HEAD symptoms for temporal lobe seizures
- Other symptoms like motor symptoms, behavioral changes, headache
HEAD stands for hallucinations, epigastric rising, emotional symptoms, automatisms, and dysphagia.
What are common triggers for seizures?
- Head injury or trauma
- Lack of sleep
- Stress
- Drugs (alcohol, clozapine, etc)
What is the difference between simple and complex seizures?
Preserved awareness indicates simple seizure; impaired awareness indicates complex seizure
Awareness during a seizure can help classify its type.
What are some features observed during a seizure?
- Tonic-clonic movements
- Other motor features
- Tongue biting
- Incontinence
- Noises or groaning
- Vacancy (absence seizure)
These features can help in identifying the type and severity of the seizure.
What are postictal symptoms to look for after a seizure?
- Injuries
- Post-ictal symptoms (disorientation, depression, Todd’s paresis)
- Headache
- Myalgia
Todd’s: transient weakness \ paralysis in one or more limbs post seizure
Postictal symptoms can vary widely and may require management.
What are differential diagnoses (DDx) to consider for seizures?
- Hypoglycaemia or electrolyte disturbance
- Syncope (cardiogenic, orthostatic, postural)
- Non-syncopal mimics (rigors, TIA, NEAD)
NEAD stands for non-epileptic attack disorder, which can mimic seizures.
What are some risk factors (RFs) for seizures?
- Birth trauma or hypoxia
- Neurodevelopmental disorder
- Febrile seizures
- CNS infections
- Trauma
- SOL
- Drugs
SOL stands for space-occupying lesions, which can increase seizure risk.
What initial tests should be conducted in a seizure evaluation?
- Point-of-care glucose
- FBC
- U&E
- Glucose
- VBG
- Blood cultures
- Toxicology screen
- AED levels
These tests help in diagnosing the cause of the seizure and guiding treatment.
What is the first-line treatment for seizures?
- Short-acting benzodiazepines (IV lorazepam, buccal midazolam, PR diazepam)
Benzodiazepines are preferred for their rapid action in stopping seizures.
What should be considered if convulsive status epilepticus does not respond to two doses of benzodiazepines?
- Levetiracetam
- Phenytoin
- Sodium valproate
These medications are considered as second-line treatments according to NICE guidelines.
What are some medications to consider under expert guidance if status epilepticus persists?
- Phenobarbital
- General anaesthesia (e.g., propofol, etomidate, ketamine)
These options are typically reserved for refractory cases and require careful monitoring.
What should be included in a follow-up for a patient who has had a seizure?
- Emergency action management plan
- EEG
- MRI brain
- +/- LP
- +/- lactate +/- CK +/- prolactin (raised in true generalised seizures, not in pseudoseizures)
Follow-up evaluations help in understanding the patient’s condition and preventing future seizures.
True or False: MRI brain is generally normal in generalized seizures.
True
Focal seizures are more likely associated with intracranial pathology.
Fill in the blank: If a patient is experiencing cluster seizures, consider giving ______ immediately.
[benzodiazepine]
Cluster seizures require prompt management to prevent further complications.
