Page 143 - PJ MED OPS Handbook 8th Ed

Seizure

SPECIAL CONSIDERATIONS:
1. May be caused by head 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.

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. Midazolam (Versed) 5mg IV/IO q5min or 5–10mg IM/IN q15min (no maximum dose) –
IV/IO preferred if able to establish it
3. Levetiracetam (Keppra) 20mg/kg IV should be administered if continued or recurrent sei-
zure following first dose of Versed
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 SpO2
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. Utilize Glucometer and administer glucose (or gel) for hypoglycemia

DISPOSITION:
1. Urgent evacuation.

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 141