Table of Contents
Include in assessment
- Capillary glucose
- Venous blood gas (to measure lactate and acidosis) and venous bloods including FBC, LFTs, U&Es, Ca2+, PO43-, Mg2+ (look for electrolyte abnormalities), antiepileptic drug levels (if taking), clotting
- ECG (look for prolonged QT interval)
- Urine toxicology screen (if relevant)
- Further investigations (if cause unknown):
- CT/MRI brain (look for any focal lesions or bleed)
- Electroencephalogram (EEG)
- Lumbar puncture (if meningitis / encephalitis suspected)
Initial ABCDE approach
- Airway
- Recovery position
- Maintain airway with jaw-thrust ± suction as required
- Consider nasopharyngeal airway if airway concerns (not oropharyngeal airway due to trismus)
- Breathing
- 15L oxygen via non-rebreather mask
- Circulation
- Secure IV access
- Attach monitoring (pulse oximetry, blood pressure, cardiac monitor)
- Disability
- Check capillary glucose
- Everything elseÂ
- Full examination

Pharmacological seizure management
If seizure ongoing, within:
- 10 minutes:Â 4mg lorazepam IVÂ ORÂ 10mg diazepam PR
- 20 minutes:Â repeat above
- 30 minutes: phenytoin 20mg/kg IV (max. 2g; at 50mg/minute with cardiac monitoring) or levetiracetam (Keppra) 40mg/kg IV (max. 4.5g; over 10 minutes)
- 60 minutes: general anaesthesia in intensive care unit
Plus:
- If hypoglycaemia: 50ml 50% glucose IV
- If any suggestion of alcohol dependence: Pabrinex I+II 2 pairs IV
- Treatment for any obvious causes
After patient has recovered consciousness
- Post-ictal period may last a few hours
- Find cause
- Full historyÂ
- Multi-system examination (including full neurological exam)
- Complete any outstanding investigations above
- Treat cause
- Refer to medical team/neurology or seizure clinic
- Give driving advice and instruct patient to inform DVLAÂ
Questions
What are three common causes of seizures?
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ÂWhen are the usual indications for starting regular antiepileptics?
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How long is the DVLA driving restriction after a seizure?
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