Seizures

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Pediatric hypotension is defined as SBP < 70 + (age in years x 2) mmHg 
□ Assess for VP shunt
□ Febrile seizures occur between 6 months and 5 years
□ Consider a broad differential including ingestion for seizures		□ Altered mental status 
□ Sleepiness 
□ Incontinence 
□ Observed seizure activity 
□ Evidence of trauma 
□ Unconscious 
□ Fever 
□ Seizure activity 
□ Tongue trauma 
□ Rash 
□ Nuchal rigidity		□ CNS (Increased ICP, headache, stroke, □ CNS lesions, Trauma, or hemorrhage) 
□ Vestibular 
□ AMI 
□ Small bowel obstruction
□ Drugs (NSAIDS, antibiotics, narcotics, chemotherapy) 
□ GI or GU disorders 
□ Uremia 
□ Gynecologic disease (Ovarian Cyst / PID) 
□ Infections (pneumonia, influenza) 
□ Electrolyte abnormalities 
□ Food or Toxin induced 
□ Pregnancy 

Clinical Management Options

EMT-B
• Oxygen, target SpO2 92 – 96% 
• Blood glucose level
• BLS airway management 
• For any seizure in a pregnant or recently post-partum patient, consider eclampsia and consult the OB Emergencies guidelines
• Examine mental status, HEENT, heart, lungs, extremities, and neuro  
Paramedic
• Stroke Assessment
• Vascular access 
• Consider Isotonic Crystalloid 
• Monitor ECG and ETCO2 
• Midazolam if the patient is actively seizing or has a seizure in your presence
• Consider Ketamine for seizures that have not improved with 2 doses of Midazolam
• Preference for IM/IN over IV for first dose if IV not already established
• Consider advanced airway
Consult Online Medical Control as Needed

Pearls

  • Status epilepticus is defined as two or more successive seizures or a continuous seizure lasting 5 minutes without a period of consciousness or recovery. This is a true emergency requiring rapid airway control, treatment, and transport. 
  • Seizures can be grand mal, focal, or staring spell. 
  • Grand mal seizure (generalized) is associated with loss of consciousness, incontinence, and tongue trauma. 
  • Focal seizures (petit mal) effect only a part of the body and are not usually associated with a loss of consciousness. 
  • Jacksonian seizures are seizures which start as focal seizure then become generalized. 
  • Avoiding hypoxemia is extremely important. 
  • Be prepared to assist ventilations, especially if Midazolam is used. 
  • Assess possibility of occult trauma and substance abuse. 
  • Addressing the ABCs and verifying blood glucose is more important than stopping the seizure. 
  • Hypoglycemia is the 2nd most common cause of seizure. 
  • Consider acquiring a 12-lead EKG following cessation of seizure in patients without a history of seizure to determine possible cardiac cause
  • In an infant, a seizure may be the only evidence of a closed head injury. 
  • The presence of fever with seizure in children less than 6 months old and greater than 6 yo is not consistent with a simple febrile seizure, and should prompt evaluation for meningitis, encephalitis or other cause
  • Seizure in a patient with a history of VP shunt may be shunt malfunction. Needs to go to the hospital where they are followed for their shunt