1. Seizures and Syncope Chapter 19

2. Objectives What is the Pathophysiology of Seizures Discuss the Types of Seizures Who perform an Assessment of Seizure Activity What is Syncope

3. Pathophysiology of Seizures Seizure – a sudden and temporary alteration in brain function caused by massive, continuing electrical discharges in a group of nerve cells in the brain Seizures produce changes in mental activity and behavior ranging from brief trancelike periods of inattention to unresponsiveness and convulsions

4. Pathophysiology of Seizures Seizures are a sign of an underlying defect, injury or disease Epilepsy – chronic brain disorder characterized by recurrent seizures Seizures of various types many cn be mistaken for other conditions

5. Pathophysiology of Seizures Seizures are categorized as either primary or secondary Primary seizures in adults are usually due to a genetic or unknown cause – Generalized seizures involve both hemispheres of the brain and the reticular activating system, often resulting in convulsions and loss of consciousness – Partial seizures are typically related to abnormal activity in just one cerebral hemisphere and are either simple (remain conscious) or complex (altered mental status or unresponsiveness)

6. Pathophysiology of Seizures Secondary or reactive seizures do not result from a genetic cause but occur as the result to an insult to the body (fever, hypoxia, drug intoxication, eclampsia) – Is often generalized in nature – Is extremely dangerous and can result in death A patient who suffers generalized motor seizures that last more than 5 minutes or seizures that occur consecutively without a period of responsiveness between them is considered to be in status epilepticus

7. Types of Seizures - Tonic/Clonic Tonic/Clonic or grand-mal Begins with abnormal electrical activity low in the cerebral cortex that spreads upward, affecting both cerebral hemispheres, and downward, affecting the reticular activating system

8. Types of Seizures - Tonic/Clonic Five Stages – Aura – Warning – Loss of consciousness – Tonic phase – Muscle rigidity – Hypertonic phase – Extreme muscle rigidity and hyperextension – Clonic phase – Convulsion – Postictal state - Recovery Emergency Care – If postictal, provide reassurance and conduct assessment – If patient refuses transport, follow protocols – If in status epilepticus, establish and maintain airway, ventilation, oxygenation, and circulation

9. Simple Partial Also known as focal motor seizure or Jacksonian motor seizure Involves only one cerebral hemisphere Produces jerky muscle activity in one area of the body but may spread to another area or progress to a generalized tonic/clonic seizure Patient remains awake and aware Document where seizure activity began and how it progressed Emergency Care – Contact Med Control (ALS) if patient refuses transport and follow local protocols

10. Complex partial Also known as psychomotor or temporal lobe seizure Involves only one cerebral hemisphere Patient will remain awake but will be unaware of surroundings Lasts 1 – 2 minutes and may include blank stare followed by random activities (chewing, lip smacking, rolling fingers) Post-seizure confusion may last longer than a few minutes Emergency Care – Stay with the person until completely aware of surroundings, follow local protocols if refuses transport

11. Absence (petit mal) & Febrile seizures Mostly common in children Characterized by blank stare, beginning and ending abruptly, and lasting one a few seconds No emergency care is necessary; if it is a first time observation, recommend medical evaluation Febrile seizures Caused by high fever, often in children 6 months to 6 years of age Most often do not need emergency care

12. Assessment-based Approach Scene size-up Look for MOI or prescription medications that may indicate history Always begin wit the assumption that the seizure patient needs care Follow protocol if patient refuses care If patient is seizing upon arrival, be sure patient receives proper care – guide movements rather than restrain

13. Assessment-based Approach Primary Assessment Form general impression Postictal state – who is talking without distress, continue with secondary assessment and realize the patient may not require emergency care

14. Assessment-based Approach For the patient that is actively seizing, unresponsive, or in status epilepticus; Open airway with jaw-thrust, or head-tilt, chin-lift Suction and insert nasopharyngeal airway as needed Begin PPV if patient is severely cyanotic, the seizure has lasted for greater than 5 minutes, or the breathing does not become adequate following the episode Note skin temperature and color Ensure pulse is present if patient is unresponsive Pulseless – Initiate CPR/AED Determine if patient is transport priority – evidence of head trauma, pregnancy

15. Secondary Assessment If patient is transport priority, conduct secondary enroute Assess head for injury and extremities for paralysis or injury Assess and record baseline vitals SpO2 BGL Gather history – when seizure started, how long it lasted, description of seizure activity Be aware seizures can be mistaken for other disorders

16. Secondary Assessment – Signs/Symptoms Convulsions Rigid muscular contraction or muscle spasm Bitten tongue, excessive saliva Urinary or bowel incontinence Chewing, smacking lips, wringing hands, or other repetitive motions Localized twitching of muscles Visual or Olfactory hallucinations

17. Emergency Care Position patient Maintain patent airway Suction Assist ventilation if necessary Prevent injury to patient Maintain oxygen therapy Transport Reassess

19. Syncope Syncope or fainting – sudden and temporary loss of consciousness Occurs when, for some reason, there is a temporary lack of blood flow to the brain, and the brain is deprived of oxygen for a brief time Common cause is the overwhelming influence of the parasympathetic nervous system that causes blood vessels to dilate throughout the body Vasovagal Faint - Type of faint in which patient is in a standing or seated position, allowing blood to pool in the lower extremities

20. Syncope Place the patient in a supine position and conduct primary/secondary assessment – Be alert for spinal injury from fall Patient may refuse transport; follow protocol Remember that syncope could be a sign of a serious illness or injury, especially in elderly patients

21. Questions ???