Seizure, Suicide + Poisoning

Question 1

RF for szs

Answer 1

stroke, head injury, emotion, fever

Question 2

Conditions that cause seizures

Answer 2

Febrile sz
Sleep deprivation
Hypoglycemia
Hyponatremia
CNS infection
Alcohol withdrawal
Substane use
Acute trauma

Question 3

Management of actively szing pts

Answer 3

Ensure good airway control (OPA, lateral decubitus position)
Use benzos to stop seizure (IN midaz for peds or IV diazepam)
R/O metabolic cause (hypoglycaemia, hypoxia, heat stroke, electrolyte imbalance)

Question 4

Counselling for szs

Answer 4

Triggers: sleep, diet, alcohol
Med adherence
Med interactions
Rescue meds
Driving
Safety
Women: avoid valproic acid, take 5mg folic acid, IUDs best contraception

Question 5

Driving rules after sz

Answer 5

Single, unprovoked: no driving x3mo
After dx: can drive if no sz for 12mo + med compliant

Question 6

Meds for generalised, absence + focal

Answer 6

Generalised: carbamazepine, lamotrigine, phenytoin
Absence: carbamazepine, lamotrigine, phenytoin
Focal: carbamazepine, phenytoin, levetiracetam

Question 7

RF for suicide

Answer 7

Prev attempt
Older men
Hx of SH
Sexual minority
Fam hx of suicide
Legal problems
SUD
PTSD
PD
Cancer
Single
Hx of abuse

Question 8

Management for low + high risk pts with SI

Answer 8

High risk - hospitalisation
Moderate/ low risk:
Contract for safety
Crisis planning
Treat underlying medical condition

Question 9

Nonsuicidal self-injury (NSSI)
DSM V criteria

Answer 9

> 5 days past year
Expects NSSI will provide relief
Experiences negative thoughts before NSSI, preoccupation with NSSI or frequent thoughts of NSSI
NSSI linked to distress

Question 10

What is involved in a Crisis plan?

Answer 10

Provide specific instructions for FU
Develop plan if sx worsen, inc signs of crisis
Self-management skills (distraction, stress relief)
Identify social and community resources
Discuss protective factors
Reduce access to lethal means

Question 11

Gastric lavage when?

Answer 11

less than 2 hrs ago, potentially lethal, no antidote available

Question 12

What to give in an unconscious patient

Answer 12

dextrose, oxygen, narcan, thiamine

Question 13

BB antidote

Answer 13

glucagon

Question 14

Iron antidote

Answer 14

desferoxamine

Question 15

Bradycardic pt rx

Answer 15

atropine

Question 16

Management of sz in pregnant pts

Answer 16

left lateral decubitus position, oxygen, mg sulphate, consider narcan, consider thiamine, consider dextrose

Question 17

2nd line sz meds for kids after benzo

Answer 17

phenytoin, valproate, phenobarbital

Question 18

What to give to prevent recurrence of febrile sz?

Answer 18

tylenol

Question 19

Reversible causes of sz

Answer 19

hypoglycemia, hypoxia, hypocalcemia, hypovolemia, heat, opioid OD, missed meds

Question 20

Precipitating factors for suicide

Answer 20

drugs/ alcohol, access to means, life events, new terminal/ chronic dz, media effects

Question 21

Predisposing factors

Answer 21

neuropsych disorders, fam hx, prev attempt, adverse childhood experiences, SES

Question 22

Risk tool for suicide

Answer 22

CFI-S - convergent functional assessment for suicide - 22 questions

Question 23

Non-suicidal self injury RF

Answer 23

female, serious MH, SUD, hx of TBI