Page 276 - ATP-P 11th Ed

SEIZURE PROTOCOL

SPECIAL CONSIDERATIONS
1. May be caused by injury, infection, high fever, alcohol withdrawal, drug use,
toxins, and structural abnormalities of the central nervous system (CNS).
2. Possible history of previous seizures, recent head trauma, CNS infection, or
headaches.
SECTION 2 Signs and Symptoms
1. Involuntary repetitive muscle movements that are abrupt in onset
2. Associated unresponsiveness
3. Typically lasts 90–120 seconds
4. Followed by period of confusion and somnolence (postictal state)
5. Evidence of recent seizure activity may include urinary incontinence and acute intraoral
trauma (e.g.: tongue biting)
Management
1. Avoid trauma to patient during the seizure, but do not restrain patient.
2. Diazepam (Valium ) 5–10mg IV/IO q5min or 10mg IM q15min to a maximum
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dose of 20mg.
a. OR midazolam 5mg IV/IO q5min or 5–10mg IM q15min (no maximum dose)
3. Fosphenytoin (Cerebyx ) 20 phenytoin (Dilantin ) equivalents (PE) PER KILO-
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GRAM (PE/kg) IV/IO at 100–150mgPE/min if available for seizures refractory to
benzodiazepines.
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Fosphenytoin (Cerebyx ) is typically administered in phenytoin (Dilantin )
equivalents (PE) per kilogram, rather than mg/kg. Ensure you properly calculate
the dosage. The normal concentration of phenytoin (Dilantin ) is 1.5mg of phenyt-
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oin (Dilantin ) per 1PE (e.g. 500mg PE in 10mL for a total of 750mg phenytoin).
Do not administer fosphenytoin (Cerebyx ) faster than 150mg/min since it may
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result in hypotension.
4. Do not attempt to force an object into the mouth to open airway.
5. Support and maintain airway and ventilation as needed to include SPO .
2
6. If seizures are accompanied by fever:
a. Consider meningitis and treat per Meningitis Protocol.
b. Consider malaria if in malaria endemic area and treat per Malaria Protocol.
7. If nerve agent, both atropine (shortly after exposure) and diazepam/midazolam are criti-
cal for stopping the seizure. See CBRN: Nerve Agent Poisoning Protocol.
Disposition
Urgent evacuation
266 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 267