MyCpdZw - Protocols Details

FITTING

Symptoms that suggest a seizure include loss of consciousness, muscle spasms that shake the body, loss of bladder control, sudden confusion, and inability to pay attention

Diagnosis

Try & obtain a history of the events leading up to the seizures:

· Talk to ambulance officers & eyewitnesses,

· Known epileptic/ diabetic,

· Other intercurrent illnesses,

· Type & duration of seizure, if still fitting when did it start,

· Any history evidence of incontinence, tongue biting or injuries.

· Other medical history including prescribed & social drugs, especially alcohol.

Status epilepticus is; “a generalized seizure lasting longer than 5-10 minutes or two or more seizures without full recovery between fits or recurrent fits lasting more than 30 minutes”.

After seizure activity is complete ensure you perform a thorough check for any injuries.

Management

1. ABC’s & Resuscitation as required,

2. Protect the patient from potential injury,

3. Oxygen 100%,

4. Observe the features of the seizure,

5. Monitoring as indicated,

6. IV access,

7. Immediate Blood Sugar Levels,

8. If fitting spontaneously stops nurse in semi-prone position & observe for 4 hours,

9. After 4/24 admit if:

· Persistent altered mental state,

· CNS infection suspected,

· New neurological deficit,

· Acute head trauma,

· Eclampsia

10. If fitting continues:

· Inform medical officer,

· Clonazepam IV 1-2 mg,

· Terminates 80-90% of “status epilepticus”

11. If seizure continues commence Phenytoin IV 10-15 mg/kg at 50mg/min,

12. If seizure continues, consider using Phenobarbitone 20 mg/kg IV 60-100 mg/min,

13. If seizure is still continuing consider anbaesthetising, paralyzing & ventilating,

14. For status epilepticus take FBC, U&E’s, LFT’s, Anticonvulsant levels (if on treatment),

BC’s (if septic), ABG’s,

15. Consider serum Prolactin (doesn’t risoe in pseudoseizure),

16. Regularly check Blood Sugar Levels,

17. Consider drug screen, CT scan & LP as indicated,

18. May require Catheterisation, urinalysis & MSU,

19. Maintenance dose of phenytoin is loo mg 6-8 hourly (PO or IV),

20. Review all possible causes,

21. Urgent CT if:

· Structural lesion suspected,

· New focal deficits,

· Persistent altered mental state,

· Fever,

· Recent trauma,

· History of cancer,

· Anticoagulation,

· HIV infection,

· New seizure pattern

Recent Protocols

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