Seizure Precautions(Archived)

Excerpt

A common, well-accepted clinical axiom in neurology is "seizures beget seizures." Therefore, seizure prevention, vigorous follow-up, and early therapy are key to success. More importantly, early treatment is not only more effective, but it also stops progression to status epilepticus. Every time seizures occur, it causes neurological dysfunction despite adequate oxygenation. Thus, it is vital to establish seizure precautions daily. One factor to consider when evaluating seizure precautions is knowledge of triggers and precipitating factors. Even though non-compliance with medications is 1 of the most common causes of breakthrough seizures, all caregivers and healthcare workers should examine these individuals for any underlying metabolic or infectious triggers. One should consider fever or any abnormal laboratory parameter as a cause in patients with therapeutic drug levels. Substance abuse screening is important in youth. Imaging studies and electroencephalograms (EEGs) are important for establishing the risk of seizure recurrence. In almost all cases, the prehospital care of patients with seizures is supportive. Most seizures only last a few seconds or minutes, especially the simple febrile seizures in children.

Initial considerations for patients with an ongoing seizure:

1. Follow the ABCs (airway, breathing, circulation) if the individual continues to have seizures.

2. Administer oxygen if the individual is in status epilepticus, is cyanotic, or is in respiratory distress. Some individuals may require rapid sequence intubation; however, one should use a short-acting neuromuscular blocker to avoid masking seizure activity.

3. Check finger stick blood glucose and replace if <50 mg/dL

4. Obtain a toxicology screen and anti-convulsant drug levels (if appropriate).

5. If the patient is intubated and paralyzed, consider EEG monitoring to determine if there is still ongoing seizure activity

6. All patients with an active seizure should have 2 large-bore intravenous lines. Administer intravenous glucose and thiamine promptly. If the patient exhibits signs of infection, obtain cultures and consider the use of antibiotics.

The primary aim of treatment is to control the seizure before any significant neuronal damage occurs, typically within 20 to 60 minutes. Anoxia and central nervous system (CNS) infections correlate with a high mortality rate in status epilepticus.