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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
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what are causes of seizures?
- hypoxia
- hypoglycaemia
- alcohol
- arrhythmias
- recreational drugs
- eclampsia
- kidney failure
- systemic infection
- brain infections
- tumour
- stroke
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what is epilepsy?
- tendency to have recurrent unprovoked convulsions
- sudden burst of intense electrical activity in the brain
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what are the types of seizures?
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what is a generalised seizure?
affect a large part of the cerebral cortex
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what is a partial seizure?
- affect a locialised part of the cortex
- they can progress to become generalised
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what are the 2 types of generalised seizures?
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describe absences seizures?
- staring/ day dreaming/ absence episodes
- may notice repetitive actions such as eye blinking
- last few seconds with immediate recovery
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what is the tonic phase in a tonic clonic seizure?
- body wide rigidity
- will fall
- may cry out
- bite tongue as the jaw clenches
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what is the clonic phase in a tonic clonic seizure?
- regular jerking movements
- may eventually slow/stop
- pt may be incontinent
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what is the prolong recovery period called in a tonic clonic?
- post- ictal phase
- pt sleepy and disorientated
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a pt having a partial seizure maybe?
- conscious
- altered LOC
- lose consciousness
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what may happen with a partial seizure?
- changes in behaviour or mood
- repetitive actions
- localised tonic clonic activity
- progress to a generalised convulsion
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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
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what is SUDEP?
- Sudden unexpected death in epilepsy
- someone dies with epilepsy unexpectedly, previously in their usual state of health
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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
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what may happen to a persons heart rhythm after a seizure?
rarely, may cause a dangerous heart rhythm or cardiac arrest
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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
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what should you remember when attending seizures?
- The FIRST, the WORST or the LONGEST
- should be transferred to hospital
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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
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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
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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
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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%
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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
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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
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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
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when would a seizure pt be time critical?
- major ABCDE problems
- serious head injury
- status epilepticus
- underlying infection
- eclampsia
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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
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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
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where should you get the dose for midazolam?
patient specific direction
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what is the route for midazolam?
- buccal
- between gums and the cheeks
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how is midazolam presented?
- glass bottle
- containing 5ml of midazolam
- 10 milligrams per ml
- supplied 1ml syringes to draw up the dose
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how many doses can we give?
after 1st dose, if the pt continues to fit for 10 minutes then give a 2nd dose
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what are the side effects of midazolam?
- respiratory depression
- hypotension
- muscle weakness
- slurred speech
- occasionally agitation, restlessness and disorientation
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