Ch. 20- Seizures, Dizziness, and Fainting

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Ch. 20- Seizures, Dizziness,and Fainting
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20.1 Causes and Types of Seizures

• Causes of Seizures
• epilepsy
• Acute head injury or stroke
• Low oxygen levels in the brain
• Drugs or alcohol
• Derangements in the bodys chemistry
• Trauma or other injury to the brain that causes
  scar formation
• Reduced blood flow to the brain
• Inflammation of the brain, usually caused by
  bacterial, viral, or parasitic infection
• Fever, usually in children 6 months to 3 years
  old
• Degeneration of the central nervous system, such
  as from multiple sclerosis
• Congenital brain defects
• Brain tumor
• Hypoglycemia or hyperglycemia
• Severe burns
• Endocrine changes during pregnancy or menstruation

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PROGRESS CHECK

• 1. One of the most common causes of seizures is
  __________.
• (epilepsy/head injury/stroke)
• 2. A seizure that causes a sudden cry or moan
  followed by muscle jerks and frothy saliva is a
  __________ seizure.
• (absence/tonic-clonic/simple partial)
• 3. An absence seizure is often mistaken for
  __________.
• (daydreaming/stroke/mental illness)
• 4. Status epilepticus means the seizure has
  lasted __________ minutes. (more than 5/10/more
  than 10)
• 5. Status epilepticus represents a dire medical
  emergency because the brain is deprived of
  _________.
• (sodium/blood/oxygen)

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Vocabulary

• Seizure- An involuntary, sudden change in
  sensation, behavior, muscle activity, or level of
  consciousness that results from irritation or
  overactivity of brain cells
• Epilepsy- A chronic brain disorder characterized
  by recurrent seizures not caused by acute
  problems, with or without loss of consciousness
• Simple partial (Jacksonian) seizure- A simple,
  partial seizure characterized by jerking in the
  fingers and toes the jerking may spread to
  involve the entire arm or leg, but the victim
  stays awake and aware. It may progress to a
  generalized tonic-clonic seizure
• Complex partial (psychomotor) seizure- A seizure
  that starts with a blank stare, then progresses
  into chewing or other random, repetitive
  activity the victim seems dazed
• Myoclonic seizure- A seizure characterized by
  sudden, brief, massive muscle jerks that involve
  part or all of the body
• Atonic seizure- Also called a drop attack, a
  seizure in which the legs of a child
  suddenly and temporarily collapse

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Vocabulary

• status epilepticus A severe, prolonged seizure
  lasting longer than five minutes or a series of
  seizures that occur without the victims
  regaining consciousness between them
• generalized tonic-clonic (grand mal) seizure A
  convulsive seizure characterized by alternating
  muscle rigidity and jerking, temporarily
  suspended breathing, and altered mental state
• absence (petit mal) seizure A seizure
  characterized by a blank stare that lasts only a
  few seconds, most common in children an absence
  seizure does not involve convulsions

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Generalized Tonic-Clonic Seizures

• 1. The aura, a peculiar warning sensation that
  lasts only a few seconds (it may be visual or
  auditory hallucinations, a peculiar taste in the
  mouth, or a painful sensation, for example)
• 2. The tonic phase lasts 15 to 20 seconds the
  victim loses consciousness, there is continuous
  muscular contraction, and the victim stops
  breathing.
• 3. The hypertonic phase lasts 5 to 15 seconds
  there is extreme muscular rigidity.
• 4. The tonic-clonic phase lasts 30 to 60 seconds
  muscular rigidity and relaxation alternate
  rhythmically and in rapid succession, there is
  frothy saliva, and the victim may lose bowel and
  bladder control.
• 5. Autonomic discharge lasts for a few seconds
  there is hyperventilation, salivation, and rapid
  heartbeat.
• 6. During the postseizure phase, the victim
  lapses into a coma.
• 7. The postictal phase- commonly called the
  recovery phase usually lasts 5 to 30 minutes,
  but occasionally several hours all
  muscles relax and the victim slowly becomes
  responsive but remains exhausted.

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Assessment Considerations

• What the seizure was like
• Whether the victim has a history of seizures
• Whether the victim takes medication for seizures
• How the seizure progressed
• Whether the victim has suffered a head injury
• Whether the victim uses drugs or alcohol
• Whether the victim has diabetes mellitus
• In performing a physical assessment, pay
  particular attention to the following
• Signs of injury to the head, tongue, or elsewhere
  on the body
• Signs of drug or alcohol abuse (such as alcohol
  on the breath or needle tracks)
• The victims mental status
• Fever
• Presence of a Medic Alert tag or other
  identifying
  medal or bracelet

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First Aid Care for Seizures

• 1. Do not move the victim unless he or she is
  near a dangerous object that cannot be moved.
  Otherwise, move objects away from the victim.
  Place padding under the victims head to prevent
  injury.
• 2. Maintain an open airway.
• 3. Stay calm if the victim is responsive,
  reassure him or her reassure others who are with
  the victim.
• 4. Stay with the victim until the seizure has
  passed if you need to get help, send someone
  else.
• 5. Never try to force anything between the
  victims teeth, and never give the victim
  anything by mouth.
• 6. Remove or loosen any tight clothing,
  especially around the neck remove eyeglasses.
• 7. Turn the victim on his or her left side with
  the face pointed downward so secretions and
  vomitus can drain quickly out of the mouth and so
  the tongue will not fall back and block the
  airway.
• 8. If the victim stops breathing, open the
  airway, remove anything that might impair
  breathing, and provide artificial ventilation.
• 9. Do not try to restrain the victim unless he or
  she is in danger from objects that cannot be
  moved.
• 10. Keep the victim from becoming a spectacle
  ask bystanders to leave.
• 11. Following the seizure, reassure and reorient
  the victim speak slowly and
  calmly in a normal tone of voice. Allow the
  victim to rest help the victim be
  as comfortable as possible.

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First Aid Care for Status Epilepticus

• This is a dire medical emergency
• 1. Place the victim on the floor or bed, away
  from other furniture. Do not try to restrain the
  victim.
• 2. Clear and maintain the airway turn the
  victims head sideways to prevent aspiration.
• 3. Administer artificial ventilation as needed
  even though it can be extremely difficult to
  administer artificial ventilation to a seizing
  person, you must do itlack of oxygen during
  seizure activity is the most serious threat to
  life.
• 4. Carefully monitor vital signs until emergency
  personnel arrive.

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PROGRESS CHECK

• 1. An aura may involve a ____________.
  (hallucination/muscle contraction/coma)
• 2. The period in which a seizure victim loses
  consciousness is the ____________ phase.
  (clonic/tonic/hypertonic)
• 3. During the ____________, the victim slowly
  recovers.
• (clonic phase/autonomic discharge/postictal
  stupor)
• 4. During assessment of a seizure victim, pay
  particular attention to signs of injury to the
  ____________. (throat/head/back)
• 5. You should activate the EMS system if the
  victim has more than ____________ seizure(s).
  (one/two/three)
• 6. The primary goal in caring for the victim of
  status epilepticus is ____________. (preventing
  injury/maintaining airway/maintaining oxygenation)

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Dizziness

• Central vertigo
• Dysfunction of the eye muscles
• Unequal pupil size
• Facial droop
• Labyrinthine vertigo
• Nausea
• Vomiting
• Rapid, involuntary twitching of the eyeball
• A whirling sensation
• Pale, moist skin
• Rapid heartbeat
• First Aid Care
• 1. Reassure the victim help the victim get in a
  comfortable position and to move as little as
  possible.
• 2. Conduct a thorough assessment to rule out any
  immediate life-threatening conditions.
• 3. Encourage the victim to see a physician.

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Vocabulary

• Vertigo- Dizziness
• Central vertigo- The least common type of vertigo
  (dizziness), which mimics a transient ischemic
  attack or stroke victims do not experience
  nausea, vomiting, hearing loss, or a whirling
  sensation
• Labyrinthine vertigo- The most common kind of
  dizziness, caused by a disturbance in the inner
  ear and characterized by nausea, vomiting, and a
  whirling sensation
• Syncope- Fainting

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Fainting

• 1. If the victim has not yet fainted, prevent him
  or her from falling by having the victim sit down
  with head between the knees or have the victim
  lie on the floor with legs elevated 8 to 12
  inches.
• 2. If the victim has already fainted, keep the
  victim in a supine position elevate the legs 8
  to 12 inches.
• 3. Monitor for possible vomiting loosen clothing
  that might restrict free breathing.
• 4. Make a rapid assessment for any
  life-threatening condition that may have caused
  the fainting initiate appropriate care.
• 5. Check for any injuries that may have occurred
  during the fall treat appropriately.
• 6. Do not allow a person who has fainted to sit
  up immediately. Instead, have the victim sit up
  slowly and gradually.
• 7. Help the victim feel better by moving him or
  her to fresh air
  or by putting a cool, damp cloth on the face.

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PROGRESS CHECK

• 1. The medical term for dizziness is
  ____________.
• (syncope/acidosis/vertigo)
• 2. The medical term for fainting is ____________.
• (syncope/acidosis/vertigo)
• 3. The most serious kind of vertigo, ____________
  vertigo, causes symptoms like those of a stroke.
  (central/positional/labyrinthine)
• 4. ____________ vertigo is caused by a
  disturbance in the inner ear.
• (Central/Positional/Labyrinthine)
• 5. Fainting occurs when the ____________ is
  temporarily deprived of oxygen.
  (heart/brain/liver)
• 6. You can prevent someone from fainting by
  placing the head ____________.
• (at heart level/between the knees/lower than the
  feet)