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Seizure management

Include in assessment

 

  • Capillary glucose
  • Venous blood gasย (to measure lactate and acidosis) andย venous bloodsย including FBC, LFTs, U&Es, Ca2+, PO43-, Mg2+ย (look for electrolyte abnormalities), antiepileptic drug levels (if taking), clotting
  • ECGย (look for prolonged QT interval)
  • Urine toxicology screenย (if relevant)
  • Further investigations
    • CT/MRI brain (look for any focalย lesions or bleed)
    • Electroencephalogram (EEG)
    • Lumbar puncture (if meningitis / encephalitis suspected)

Initial ABCDE approach

  • Airway
    • Recovery position
    • Maintain airway with jaw-thrust ยฑ 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 else
    • Full examination
Recovery position

Pharmacological seizure management

Please note OSCEstop content is for educational purposes only and not intended to inform clinical practice. OSCEstop and authors take no responsibility for errors or the use of any information displayed. Drugs and doses are intended for non-pregnant adults, who are not breastfeeding, with normal renal and hepatic function.

If seizure ongoing, within:

  • 5 minutes:ย 4mg lorazepam IVย ORย 10mg diazepam PR
  • 10 minutes:ย repeat above
  • 15 minutes: loading withย levetiracetam (Keppra; unlicenced) or phenytoin ( with cardiac monitoring)
  • 30-60 minutes:ย general anaesthesiaย in intensive care unit

Plus:

  • If hypoglycaemia:ย glucose IVย (e.g. 100ml 20% glucose) then recheck
  • 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 history 
    • 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 DVLA 

Questions

What are three common causes of seizures?

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When 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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Try an OSCE station

  1. Status epilepticus
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