Prince William County Department Of Fire

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Prince William County Department Of Fire
RescueTraining Division

• ALS Protocol Review
• Seizures (19)

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Seizures

• A sudden episode of abnormal brain cell
  electrical activity resulting in a period of
  abnormal muscular activity and/or abnormal
  behavior
• Epilepsy
• Spontaneous seizures that occur over a span of
  years
• More than one seizure
• 1 of population
• 2 5 of pediatrics will experience febrile
  seizures

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Understanding Seizures

• The Cerebrum of the brain is divided into two
  hemispheres
• The right hemisphere generally controls the left
  side of the body
• The left hemisphere generally controls the right
  side of the body

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Areas Of The Brain

• Certain areas of the brain control certain body
  functions
• Speech
• Vision
• Auditory
• Memory
• Certain areas are silent
• Function is not understood

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Material Of The Brain

• The central nervous system and the peripheral
  nervous system are composed of neurons
• Electrical signals are transmitted through them
• Neurons do not touch each other
• Require chemical transmitters to link them with
  each other

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Seizures

• Seizures are the result of abnormal electrical
  activity of the neurons
• How a seizure presents is dependent upon the area
  of the brain that is affected. Seizures can
  affect
• One area of the body
• One side of the body
• The full body
• 90 of all seizures last lt 2 minutes

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Common Causes of Seizures

• 65 of all seizures have no known cause
• Congenital
• Prenatal/infancy
• Trauma/ICB
• Direct and post injury
• Stroke
• Tumor
• 1 in 5 gt the age of 21 with new onset of seizures

• Infection/fever
• Meningitis, hydrocephalus
• Metabolic
• Low Na, low sugar, hypoxia, etc.
• Includes eclampsia
• Overdose, withdrawal, and poisoning
• Kidney/liver failure
• Compliance failure
• Does not take prescribed medication

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Types Of Seizures

• 32 Types of seizures
• Can be put into three categories
• Focal motor seizures
• Behavioral seizures
• Generalized major motor seizures

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Focal Motor Seizures/Simple Partial Seizures

• Abnormal movements (tremors) of parts of the body
• Arm, hand, leg
• Abnormal neuron discharge is isolated to one area
  of the brain
• May spread throughout the body, but patient
  remains conscious
• Jacksonian seizure

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Behavioral/Complex-Partial Seizures

• Brief absence spell
• Staring off into space
• May make purposeful movements
• Pediatrics
• Petit mal seizures
• A loss of awareness
• Blank stare
• Usually lasts lt 30 seconds
• Most commonly seen in pediatrics
• Adults
• Temporal lobe seizures
• Aura
• Lip smacking
• Pulling at clothing
• Usually no memory of seizure

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Generalized/Full Body/Grand Mal Seizures

• Composed of four distinct phases
• Aura
• Seeing, smelling, or hearing something unusual
• Tonic
• Total body rigidity
• Clonic
• Muscle spasms (shaking)
• Postictal
• Gradual return to baseline LOC
• Aprx. 30 minutes

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Complications With Generalized Seizures

• Trauma owing to fall or thrashing movements
• Tonic/clonic phase can at times cause
• Muscular/skeletal injury
• Breathing may become impaired during tonic/clonic
  phase
• Airway compromise from hypersalivation and
  possible vomiting
• Injury to tongue
• Urinary and rectally incontinence
• Tonic/clonic phase lasts more than 5 minutes

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Status Epilepticus (SE)

• A seizure lasting gt 30 minutes or a series of
  seizures lasting gt 30 minutes without a period of
  return to baseline LOC
• A true emergency
• Incidence 60,000 195,000 cases per year in USA
• 1 8 of all hospital admissions
• 10 - 12 of new seizure activity present with SE
• 15 - 27 of all epilepsy patients will have at
  least one episode of SE

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Historical Information That Should Be Gathered

• F Focus was there a single initiating movement
  or simply generalized body involvement from the
  onset?
• A Activity what movements took place during the
  event?
• C Color did the patient become cyanotic?
• Cocaine could the patient have taken cocaine or
  another stimulant?
• T Time How long did the seizure last?
• S Secondary information
• What was the patient doing before the seizure?
• Was there an aura?
• Is the patient incontinent?
• Is there a history of seizures?
• Medications? Compliant?

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Seizure Treatment (BLS)

• Administer high-flow O2 (NRB)
• BVM if hypoventilating
• Maintain airway as best as possible
• Insert nothing by mouth if teeth are clenched
• Suction if necessary
• Do not restrain seizure patient
• Protect from further injury
• Protect C-spine if there is a possibility of
  trauma
• Obtain blood sugar level
• Cool hyperthermic patients (gt 102 degrees F)
• Spritz or compresses (discontinue if shivering
  ensues)

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Seizure Treatments (ALS)

• Cardiac monitor
• Treat life-threatening dysrhythmias
• IV NS KVO (600 cc/hr if hyperglycemic)
• Persistent or multiple seizures, or if patient
  does not regain consciousness
• Thiamine 100 mg slow IV
• If indicated for adult patients
• If Hypoglycemic
• Dextrose 50 25 gm/50 ml (adult)
• Dextrose 25 0.5 gm/kg (2 ml/kg) (pediatrics)

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Seizure Treatments (ALS continued)

• Narcan (for suspected drug overdose)
• up to 2 mg IVP (titrated)
• Ativan (for active grand mal seizure)
• Adult and pediatric
• Up to 2 mg slow IVP (titrated)
• May repeat once after 3 5 minutes)
• Note Ativan must be diluted in an equal volume
  of normal saline prior to IV administration

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Seizure Treatments (ALS continued)

• If unable to start an IV
• Thiamine (if indicated)
• 100 mg IM (adult)
• Glucagon (if hypoglycemic)
• 1 mg IM (adult)
• 0.5 mg IM (pediatric)
• Narcan (for drug overdose)
• 2 mg IM or ET (adult)
• Ativan (for active grand mal seizure)
• 4 mg rectal (adult pediatric)