Page 39 - 2023 SMOG Digital

Medical

SEIZURE

Signs and Symptoms: Differential Diagnosis:
• Decreased Mental Status • CNS Trauma
• Seizure Activity • Tumor/Mass/Infection
• Somnolence • Metabolic
• Incontinence • Hypoxia
• Evidence of Trauma • Electrolyte Abnormality
• Loss of Consciousness • Drugs/Toxins
• Oral Injuries (e.g., Tongue, • Alcohol/Benzodiazepine Withdrawal
Buccal) • Stroke
• Eclampsia
• Hyperthermia
• Hypoglycemia
Universal Patient Care Guideline LORAZEPAM 2-4mg IV/IM
Continued from: O2 (if Hypoxemic) OR
Tactical Evacuation Guideline IV / IO Guideline
Cardiac Monitor
Patient Safety (ensure secured to litter) MIDAZOLAM
5mg IV/IO/IN or 10mg IM/IN
50% Dextrose 25g IV YES Blood Glucose <60 0? May Repeat Anticonvulsants 2x q3-5min
NO, Postictal (Must Have Definitive Airway Control)
AIRWAY Guideline for RSI
OR Having Active Seizure? YES

Glucagon 1mg IV/IM
NO
NO Evidence of Significant Trauma? Status Epilepticus:
NO Glucose 60-250? YES Keppra 40-60mg/kg over (max 4500mg) IV
over 15min
SPINAL IMMOBILIZATION
YES GUIDELINE
Consider:
Recurrence of Seizure? NO Pregnancy (Obstetric Emergency) Mag
Consider: HEAD INJURY Guideline Sulfate 4g IV o over 15min Monitor for
YES Hypotension
Restart Guideline at:
i
m
5
q
1
Having Active Seizure? Monitor and Reassess q15min n Consider: AIRWAY Guideline
When appropriate, return to:
Tactical Evacuation Guideline Consider Elevated ICP
HEAD INJURY Guideline
Pearls:
• Status epilepticus defined as seizure >15min or two or more continuous seizures without a period of
consciousness/recovery. This is a real emergency requiring rapid airway control, treatment, and transport to the
nearest suitable medical treatment facility.
• Paralysis for airway control does not stop seizure activity–only hides it. A seizure is a CNS electrical
phenomenon and damage is still being done even when no muscular activity seen due to paralysis.
• Anticipate further seizure activity/recurrence and monitor continually.
• Assess probability of toxin, occult trauma, abuse, or substance use.
• Be prepared to assist with ventilations with the use of midazolam. If airway controlled and ventilating well – may
give total of 4 doses of midazolam.
• In pregnant patients, magnesium should be first line to abort non-epileptic seizures. Midazolam should
only be used if this fails (pregnancy class D).
• Adult alcohol withdrawal or malnutrition (Thiamine 100mg IV)
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