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- Having epilepsy
- <5 years old or elderly
- Genetic predisposition
- Mental handicap
- Structural brain pathology
Essentially, take a look at generalised tonic-clonic seizure for more detail but it's basically: a tonic phase - everything goes rigid; and a clonic phase rhythmical shaking.
- Pulse oximetry
- Blood gas - check for acidosis
- Blood glucose - abnormal blood sugar can cause seizure
- U+Es - any electrolyte abnormality can cause seizure
- Anti-epileptic drug levels
5ml of blood and 50ml of urine for later sampling. Of the patients, not yours or some random persons. That'd be weird.
Ensure head is protected; move them away from a dangerous area (like by stairs, swimming, near an angry lion); if possible, remove false teeth and don't get your fingers bitten off, remove constricting neck-wear (particularly important for those engaged in heavy bondage); call an ambulance
- Secure airway with a Guedel or nasopharyngeal tube if possible
- Give O2
- Monitor cardiorespiratory function and assess blood pressure
- Establish iv access - take bloods
- Lorazepam - 4mg/2min iv. Watch out for respiratory arrest and have resus kit ready. (Alternative is diazepam 10mg/2min iv. This can be repeated 5mg/min until seizures stop or 20mg given.) Rectal diazepam if iv access cannot be gained and buccal midazolam (10mg[1ml] adults; 0.5ml 1-4 year olds; 0.25ml 6-12mo.) is a final option.
- Phenytoin infusion 15mg/kg iv </=50mg/min (don't mix with diazepam). Monitor BP and ECG. Don't give in bradycardia or heart block.
- If fits don't stop - diazepam infusion 100mg in 500ml of 5% dextrose, 40ml/h (3mg/kg/24h). Monitor closely, check not pseudoseziure.