EMT Seizures and Syncope

status epilepticus

generalized motor seizures that last more than 5 minutes or seizures that occur consecutively without a period of responsiveness between them.

Some serious causes of syncope

MI, cardiac dysrrhythmias, stroke or TIA, hypovolemia or blood loss, drug use or poisoning, pulmonary embolism, cardiac tamponade

Differences between seizure and syncope

Patient usually begins in a standing position Patient remembers feeling faint or light headed Patient becomes responsive almost immediately after becoming supine Skin is usually pale and moist

emergency medical care for seizures

Position the patient (lateral recumbent), maintain airway, suction, assist ventilation if needed, prevent injury to the patient, maintain adequate oxygenation, transport

Signs and symptoms of generalized tonic-clonic seizure

Aura- warning a seizure is going to begin, some type of sensory perception by the pt Loss of consciousness Tonic phase (muscle rigidity) Hypertonic phase Extreme muscle rigidity with hyperextension of the back Clonic phase (convulsion) muscle spasms alternate with relaxation Postictal state- recovery phase. Mental status usually altered, but improves over time.

generalized tonic-clonic seizure

Grand mal. Usually begins with abnormal electrical activity low in the cortex that spreads upward affecting both hemispheres and downwards affecting the reticular activating system. If RAS disturbed, pt will become unconscious.

Absence (petit mal) seizure

blank stare, beginning and ending abruptly, most common in children. Last only a few seconds.

Generalized seizures

both hemispheres of the brain and the reticular activating system, typically resulting in loss of consciousness. Usually have rhythmic tonic-clonic muscle contractions.

epilepsy

chronic brain disorder characterized by recurrent seizure activity.

Febrile seizure

convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body. Often short and may not require emergency care.

Common signs and symptoms of seizure activity

convulsions, rigid muscular contraction or spasm, bitten tongue, excessive saliva, urinary or bowel incontinence, chewing movement, smacking lips, wringing hands, or some other repetitive activity, localized twitching of muscles, visual or olfactory hallucinations

Syncope

fainting or sudden loss of consciousness caused by lack of blood supply to the cerebrum. Common cause is overwhelming response of parasympathetic nervous system that causes vessels to vasodilate (vasovagal faint)

Simple partial seizure

focal motor seizure or Jacksonian motor seizure. Involves only one cerebral hemisphere and generally only produces jerky muscle movement in one area of the body. Pt remains awake and aware, activity may move from one area of body to another or progress to generalized seizure.

secondary or reactive seizures

occur as the result of an insult to the body, such as fever, infection, hypoxia, hypoglycemia, hyperglycemia, drug intoxication, drug withdrawal, eclampsia in pregnancy, degenerative brain diseases, or imbalances in the electrolytes in the body. Generalized in nature. ID and treat the UNDERLYING CAUSE

Complex partial seizure

psychomotor or temporal lobe seizure. 1-2 minutes. Involves only one cerebral hemisphere, pt remains awake but not aware of his surroundings. Usually starts with a blank stare followed by random activity. Postseizure confusion may last a long time.

Partial seizures

simple: will remain conscious complex: normally produces an altered mental status or unconsciousness

Seizure

sudden and temporary alteration in brain function caused by massive, continuing electrical discharges in a group of nerve cells in the brain. Can range from brief trancelike periods of inattention to convulsions (jerky muscle contractions)

Primary seizures

usually due to a genetic or unknown cause. Characterized as generalized or partial seizures.