1. what are convulsions/ seizures/ fits?
    • abnormal/ excessive/ erratic activation of a set of neurons in the cerebral cortex 
    • most convulsions last less than 5 minutes
  2. what are causes of seizures?
    • hypoxia 
    • hypoglycaemia 
    • alcohol 
    • arrhythmias 
    • recreational drugs 
    • eclampsia 
    • kidney failure 
    • systemic infection 
    • brain infections 
    • tumour 
    • stroke
  3. what is epilepsy?
    • tendency to have recurrent unprovoked convulsions 
    • sudden burst of intense electrical activity in the brain
  4. what are the types of seizures?
    • generalised 
    • partial
  5. what is a generalised seizure?
    affect a large part of the cerebral cortex
  6. what is a partial seizure?
    • affect a locialised part of the cortex 
    • they can progress to become generalised
  7. what are the 2 types of generalised seizures?
    • absences 
    • tonic clonic
  8. describe absences seizures?
    • staring/ day dreaming/ absence episodes 
    • may notice repetitive actions such as eye blinking 
    • last few seconds with immediate recovery
  9. what is the tonic phase in a tonic clonic seizure?
    • body wide rigidity
    • will fall 
    • may cry out
    • bite tongue as the jaw clenches
  10. what is the clonic phase in a tonic clonic seizure?
    • regular jerking movements 
    • may eventually slow/stop 
    • pt may be incontinent
  11. what is the prolong recovery period called in a tonic clonic?
    • post- ictal phase 
    • pt sleepy and disorientated
  12. a pt having a partial seizure maybe?
    • conscious 
    • altered LOC 
    • lose consciousness
  13. what may happen with a partial seizure?
    • changes in behaviour or mood 
    • repetitive actions 
    • localised tonic clonic activity 
    • progress to a generalised convulsion
  14. what is a status epilepticus?
    • continuous seizures or a series of seizures close together without a recovery period in between them 
    • time scale of about 30 minutes for it to be status
  15. what is SUDEP?
    • Sudden unexpected death in epilepsy 
    • someone dies with epilepsy unexpectedly, previously in their usual state of health
  16. what may happen to a persons breathing after a seizure?
    • cause a person to briefly stop breathing (apnoea) 
    • airway may get blocked, leading to suffocation
  17. what may happen to a persons heart rhythm after a seizure?
    rarely, may cause a dangerous heart rhythm or cardiac arrest
  18. what may happen to a persons brain function after a seizure?
    • suppress or interfere with the function of vital areas in the brain stem
    • responsible for breathing and HR
  19. what should you remember when attending seizures?
    • The FIRST, the WORST or the LONGEST 
    • should be transferred to hospital
  20. how many seizures stop after 10 minutes?
    • 80% of cases 
    • assessment could be on a pt who is currently having a seizure, post ictal phase or a pt who has recovered
  21. what would you do for response for a primary survey on a seizure pt?
    • AVPU - determine if pt is actively convulsing, in post ictal phase or recovered 
    • if activity convulsing- call for para backup 
    • if reduced LOC= protect from injury, consider recovery position
  22. what would you do for airway for a primary survey on a seizure pt?
    • may be clenched shut- trismus (lock jaw)
    • may be bitten tongue 
    • may be impossible to assess 
    • no OP
  23. what would you do for breathing for a primary survey on a seizure pt?
    • may be hard to assess
    • consider ETCO2
    • O2 15 Lpm until reliable SPO2 measurement can be obtained, then titrate to 94-98%
  24. what would you do for circulation for a primary survey on a seizure pt?
    • may be hard to assess pulses (expect pt to be tachycardic) 
    • cap refill
    • skin colour and texture 
    • check for blood on the flood and four more
  25. what would you do for disability for a primary survey on a seizure pt?
    • reassess AVPU 
    • is seizure being caused by head injury? 
    • BM- convulsing may be a presenting sign of hypoglycaemia
  26. what would you do for expose for a primary survey on a seizure pt?
    • medic alert jewellery 
    • check for an injuries and for incontinence 
    • signs of underlying infection eg rash, pyrexia (raised body temp) 
    • protect pt from injury 
    • consider pt dignity
  27. when would a seizure pt be time critical?
    • major ABCDE problems
    • serious head injury 
    • status epilepticus 
    • underlying infection 
    • eclampsia
  28. what would you do for a seizure assessment? either on route or on scene if time critical
    • cont monitor vital signs 
    • temp (look for infection)
    • BP
    • ECG- look for arrhythmias 
    • GCS
    • 2nd survey 
    • PtHx
  29. what management options do you have for seizures?
    • para backup 
    • airway protection
    • O2 therapy- 15lpm until spo2 is achieved 
    • protect from danger and injury 
    • pts own midazolam if appropriate 
    • care during post ictal phase 
    • reassurance
  30. where should you get the dose for midazolam?
    patient specific direction
  31. what is the route for midazolam?
    • buccal
    • between gums and the cheeks
  32. how is midazolam presented?
    • glass bottle 
    • containing 5ml of midazolam 
    • 10 milligrams per ml 
    • supplied 1ml syringes to draw up the dose
  33. how many doses can we give?
    after 1st dose, if the pt continues to fit for 10 minutes then give a 2nd dose
  34. what are the side effects of midazolam?
    • respiratory depression 
    • hypotension 
    • muscle weakness 
    • slurred speech 
    • occasionally agitation, restlessness and disorientation
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