Seizures: A whole lot of shaking going on

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Seizures A whole lot of shaking going on

• Prepared By Bill Milan NREMT-P, CCEMTP

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Objectives

• Define what a seizure is
• Discuss different Seizure Classifications
• Discuss common causes of seizures
• Discuss treatments of seizure patients

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So what is a seizure?

• It is a sudden and temporary alteration in brain
  function caused by massive electrical discharge
  in a group of nerve cells in the brain that
  generally causes changes in mental activity and
  behavior ranging from trancelike periods to
  unresponsiveness and jerking muscle spasms

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Now what in the world is he talking about?

• Electrical transmission occurs at the synaptic
  cleft.
• During seizures the discharge is a lot more than
  usual and the muscles begin to twitch

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Normal electrical transmission

• Here is the normal electrical transmission of
  energy across the synaptic cleft
• Just remember during a seizure this it greatly
  increased causing the muscles to be over activated

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Seizure Classification

• Seizures are classified into two major
  categories Generalized and Partial seizures

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Generalized Seizures

• Primary Generalized Seizure There is a specific
  area of the brain that the seizure occurs
• Secondary Generalized Seizure These become more
  widespread to other areas of the brain. Most
  patients that have secondary seizures have mixed
  seizures
• Undetermined Generalized Seizure

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Classifying General Seizures

• Tonic Clonic ( also know as Grand Mal)
• In the Tonic phase the muscles tone or stiffen
• In the Clonic phase the muscles start to jerk
• This seizure will usually last approximately 2-3
  min.

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Classifying General Seizures

• Absence( also know as Petit Mal)
• This seizure usually causes a few seconds lapse
  of awareness
• May be accompanied by the eyelids or eyes rolling
  back into the head
• May look like daydreaming or staring off into
  space
• This seizure can occur 50 to 100 times a day

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Classifying General Seizures

• Myoclonic
• This seizure is accompanied by rapid, brief
  muscle contractions usually involving both sides
  of the body

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Classifying General Seizures

• Atonic ( also know as drop attacks or akinetic
  seizures)
• These seizures causes rapid loss of muscle tone,
  which causes loss of posture

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Partial seizures

• A simple partial does not impair consciousness.
  A seizure involving more complex types of
  reactions such as unconscious behaviors are
  complex partial. Partial seizures are sometimes
  accompanied by and aura(feeling of déjà vu or a
  sensation that something is going to happen)

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Classifying Partial Seizures

• Simple Partial Seizure ( also know as focal
  motor, focal sensory, or Jacksonian)
• Twitching or jerking an arm or leg
• Exhibiting an inappropriate sensation or emotion
• Last approximately 30 seconds

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Classifying Partial Seizures

• Complex Partial ( Also know as temporal lobe or
  psychomotor)
• Exhibiting automatisms such as smacking ones
  lips, mumbling, wandering, picking at clothes, or
  repeating actions
• Person is usually confused after seizure

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Epilepsy

• A chronic brain disorder characterized by
  recurrent seizures

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Status Epilepticus

• Seizures that last more than 10 minutes in
  duration or seizures that occur consecutively
  without a period of consciousness

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Common Causes of Seizures

• High Fever
• Infection
• Poisoning
• Hypoglycemia
• Hyperglycemia
• Head Injury
• Epilepsy
• Hypoxia

• Stroke
• Drug and Alcohol withdrawal
• Dysrhythmias
• Hypertension
• Eclampsia
• Idiopathic ( unknown causes)

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Febrile Seizures

• Are convulsions brought on by fevers in infants
  and small children
• Usually occur in children ages 6 months to 5
  years of age
• They can range in duration from seconds up to 15
  minutes
• The majority of patients have rectal temps of
  greater than 102 degrees

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Phases of a seizure

• AuraThis is where the patient has an abnormal
  twitch, anxiety, dizziness, a smell or odor, or a
  unpleasant feeling in stomach, visual
  disturbances, or odd taste just prior to seizure
• Tonic Phase Muscle rigidity begins with arching
  of back
• Hypertonic Phase The patient has extreme
  muscular rigidity and hyperextension of back
• Clonic Phase Muscle spasms with alteration of
  relaxation producing jerking action, also loss of
  bowel and bladder control along with alteration
  in respiratory pattern. Also the tongue, lips and
  mouth may be bitten this phase usually last 1-3
  minutes
• Postictal Phase This is the recovery phase when
  patient is confused but regains senses in 10-30
  minutes

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Assessing the Seizure Patient

• Ensure scene safety
• Approach patient and obtain c-spine due to
  possible trauma
• Assess responsiveness
• Ensure adequate airway
• Provide oxygen therapy
• Obtain information from bystanders or from
  medical ID bracelets
• Obtain medicines that patient may be taking

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Common Medications used to treat seizure patients

• Phenytoin (Dilantin)
• Phenobarbital
• Ethosuximide ( Zarontin)
• Carbamazepine (Tegretol)
• Valproic Acid ( Depakene or Depakote)
• Primidone (Mysonline)
• Clonazepam (Clonopin)
• Clorazepate ( Traxene)
• Felbamate (Felbatol)
• Neurontin

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Seizure Medications and types

• Drug Seizure Type
• Phenytion(Dilantin)
  GTCS, PS
• Phenobarbital GTCS,
  PS
• Ethosuximide(Zarontin)
  Absence
• Carbamazepine(Tegretol)
  GTCS,PS
• Valproic Acid(Depakene,Depakote)
  GTCS, PS,Absence
• Myoclonic
• Neurontin PS
• Felbamate(Felbatol) PS, LGS
• 
  

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BLS Treatment for Seizure Patients

• Scene Safety
• Assess responsiveness using c-spine
  immobilization
• Open airway and suction if needed
• Ensure breathing and oxygen therapy which may
  include BVM with 100 oxygen and use of oral or
  nasopharyngeal airway
• If patient is still seizing protect patient from
  further harming themselves
• If this is possibly a febrile seizure attempt to
  cool patient with tepid water
• Transport patient
• If patient is still seizing or begins seizure in
  presence call for ALS back up

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BLS PLUS Care

• Establish IV access
• Cardiac Monitor for arrhythmias
• Check Blood Glucose
• If patient is actively seizing or has seizure in
  your presence administer and anticonvulsant such
  as Valium 5-10 mg for adults and 0.5mg/kg for
  pediatrics or Ativan up to 2 mg for adults
• If airway becomes compromised or patient has
  status epilepticus consider intubation to secure
  airway

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Summary

• Seizures are a result of a disruption in the
  electrical pathways in the brain with many
  underlying causes to make this happen. The most
  productive thing we can do for these patients is
  to make sure they do not further injure
  themselves while protecting their airways and
  stopping the seizure activity.

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Questions?

• If not thank you very much for your attention
• Now who is the guy who bored us to tears on this
  subject