approach to seizure

seizure

Seizures require both prompt resuscitation and an approach to diagnosis that includes a wide differential–considering non-convulsive events (eg syncope), a broad etiology of seizure, and potential complications. Using a systems-based approach can help:

A

  • C-spine injury, tongue biting complication complication

B

  • hypoxia as cause of seizure or consequence of aspiration/chest injury

C: CARDIOVASCULAR

  • Cardiac arrhythmia (eg prolong QT) or other cause of syncope misdiagnosed as seizure
  • Abdominal bleed after fall

D: NEURO

  • Neuron seizure: primary seizure disorder
  • Encephalitis/meningitis
  • Unregulated pressure
  • RBC bleed/clot
  • Onco tumour

E: ENDO

  • Electrolyte: hypoglycemia, hyponatremia, hypocalcemia, hypomagnesemia
  • Normothermia: febrile seizure

F: PELVIC, CREATININE

  • pregnant: pre-eclampsia
  • uremia

G: ABDOMINAL

  • Ammonia: hepatic encephalopathy

H: HEME

  • bleeding risk

I: INTOX

  • Ingest: cocaine, alcohol withdrawal
  • N
  • Treatment: INH toxicity, missed dose of anti-seizure medication
  • O
  • X poison causing SEIZE: Sympath/salicylate Ethylene glycol/ethanol withdrawal INH/insulin benZo withdrawal Elevate mood (Li, TCA)

J: joint/skin/bones

  • MSK injury post fall

 

Putting this together into resuscitation, diagnosis and treatment

  • A: protect airway, consider C-collar
  • B: oxygen, ultrasound/CXR if chest trauma
  • C: ECG r/o arrhythmia (eg long QT); consider syncope vs seizure; ultrasound/CT if abdominal trauma
  • D: anti-seizure medication (eg ativan +/- dilantin +/- propofol if status); consider CT r/o bleed/mass, LP/antibiotics r/o infection
  • E: check beside glucose, measure extended lytes
  • F: measure urea; if pre-eclampsia –> magnesium, labetalol, OBGYN
  • G: meausure ammonia if liver disease
  • H: measure platelets/coag if intracranial bleed or sepsis
  • I: measure anti-seizure medication levels, consider ingestions/withdrawals
  • J: r/o MSK injuriries

seizure

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