Seizures

Seizures

Neurological

There are two types of seizures, Unprovoked and provoked seizures. Unprovoked seizures are usually due to a genetic or unknown cause. A common one that is known is Epilepsy. Epilepsy is a chronic brain disorder and is recurrent from unprovoked seizures. Unprovoked seizures are categorized as generalized or partial seizures. Generalized seizures involves both sides of the brain. Partial seizures start from a specific area in the brain and can be complex or simple. In a partial seizure the Patient will remain awake and aware unless it is a complex seizure they will just remain awake. A provoked seizure is the result of an insult to the body like a fever, infection, hypoxia, hypoglycemia, hyperglycemia, drug intoxication, drug whithdrawal, eclampsia in pregnancy, degenerative brain diseases, toxins, shock, stroke, Hyperthermia, traumatic brain injury, poisoning, or imbalances in the elctronolytes in the body.

Pathophysiology Of Seizures

Generalized Nonconvulsive Seizures Absence - Absence was once known as a petit mal seizure and is most common in children. This type of seizure does not involve convulsive activity and a sudden cessation of conscious activity with a lack of vocalization. The patient will have a blank stare and lasts for only about 5 to 15 seconds. Myoclonic - This seizure involves sporadic brief jerks of the muscle groups on both sides of the body. It can be described as electrical shocks and often occur during sleep. Tonic - This seizure is a sudden onset of greatly increased muscle tone in the body, arms, or legs causing sudden muscular rigidity. This happens during sleep and last for up to 20-30 secounds. Atonic - This seizure is the opposite of Tonic and means the patient will lose all muscle tone and have no muscle strength. The patient is conscious and recovers almost immediately.

The type of seizure a patient will experience will depend on where in the brain the abnormality of electrical activity begins, the level of awake and awareness, RAS involvement and the cause.

Generalized Convulsive SeizuresTonic-Clonic - This type of seizure starts with an abnormal electrical activity low in the cerebral cortex and will spread, affecting both cerebral hemisperes and then affect the reticular activating system (RAS). This type of seizure, the patient will not remain awake or aware. The patient will show characteristics like being jerky and convulsive motor activity involving the entire body.

Types Of Seizures

Generalized Convulsive Seizures Cont.

Febrile - Is a seizure that is associated with a high fever without any evidence of intracranial infection or other definite cause of seizure. This seizure is most common in children between the ages of 3-6 months and 5-6 years. Partial Seizures Motor seizures - Only one part of the body is jerky or stiffens and may spread throughout the one side. Sensory seizure - It will mess with the patients sense of smell, hearing, or other parts of the sensory system. Autonomic seizure - The patient may feel unpleasant sensations in the stomach, head, or chest. There can be changes in the heart rate, respiratory rate or even get goose bumps. Psychic seizure - This will affect the patient on how they think, feel, or experience things. This can also affect memory, speech, create fear, depression, or deja vu.

Types of Seizures

You are dispatched to a 36 year old male who is having a seizure. When you arrive on scene, you find the patient sitting up against a wall. He is disoriented and is agitated. What initial management is indicated for this patient? I would be looking for any visible head injuries and can he hurt himself or us. An EMS provider must ensure BSI, the scene is safe. Then a visual look at the area and a general impression of the patient. He is against the wall, disoriented and is agitated. Then looking for any visual head injuries. Then try to speak to the patient and let him know who we are and try to calm the patient down while checking A,B,C's. Since he is sitting up ensure that he is safe from hurting himself and check HEENT, JVD, c-spine, extremities and get vitals. Try to get SAMPLE and OPQRST. Then stablize the patient in fowlers position on the cot. Then conduct secondary assessment by checking vitals and the rest of the body again. Then transport the patient. The patients vitals will be assessed every 5 minutes until his care is handed over to the hospital.

The Patient And Assessment

Mistovich, Joseph J., and Keith J. Karren. Prehospital Emergency Care. 12th ed., Pearson, 2024. Book Pages 686 - 672

https://www.cedars-sinai.org/blog/differences-between-stroke-seizure.html

https://www.istockphoto.com/search/2/image-film?phrase=human+nervous+system

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