Management of seizures follows the same basic modality as treatment of any medical complaint. We treat ABCs first, manage the underlying problems, and provide transport to the ED. Most cases of seizure have resolved prior to EMS arrival, and the patient is typically post-ictal. Management of the post-ictal patient is focused primarily on supportive care, while identifying and treating the potential underlying cause of the seizure activity. What I want to focus on here is management of the patient in active seizure. What follows is an excerpt from the pocket guide I wrote and keep on me for whenever I need a refresher.
Seizure:
Seizures occur as a result of unregulated activity in the brain. Causes vary, but typically include:
Structural causes: Elevated ICP, Tumours, bleeding, trauma.
Metabolic causes: Hypoxia, hypoglycemia, hypoxia, electrolyte imbalances.
Febrile causes: Children <5 years old can have febrile seizures.
There are several types:
Tonic-clonic
Absence
Simple partial
Complex partial
Regardless of type, most seizures we treat are either active seizures or post-seizure patients in a
postictal state. In patients with a known seizure disorder, we can expect a typical pattern of trigger,
seizure, and recovery. Patients without any prior history require further investigation and history taking
to attempt to determine the cause. However, before we can get any information, our priority is to STOP
THE SEIZURE. If you are BLS, call for ALS backup on any active seizure.
Treatment plan:
ACTIVE seizure:
-Maintain airway with an NPA
-Suction secretions
-PPV the apneic patient, apply supplemental oxygen to the spontaneously breathing one
-Establish SPO2 and ETCO2
-Check BGL
-Establish IV access and provide benzodiazepine if authorized.
- Obtain a 12- lead ECG in all patients with first time seizure
POST-SEIZURE:
-Maintain ABCs
-Continuously evaluate GCS for improvement.
-Obtain vitals and BGL
- 12- lead for first time seizures
Comments