Neurological Emergencies Headaches, Seizures and Syncope Presence Regional EMS November 2015 CE.
+ Module Two: Recognition and Care of Seizures and Emergencies There is an option for the...
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Transcript of + Module Two: Recognition and Care of Seizures and Emergencies There is an option for the...
+Module Two: Recognition and Care of Seizures and EmergenciesThere is an option for the participant to listen to audio
synced to PowerPoint presentation, along with the option to download the modules in PDF format
+Objectives of ModuleTwo:
Upon completion of Module Two-the participant will:
Recognize generalized and partial types of seizures.
Demonstrate basic first aid for seizure types.
Identify when a seizure may become an emergency situation.
+Types of Seizures Generalized
Involves the whole brain from the onset
Types: Absence Myoclonic Clonic Tonic Tonic-clonic Atonic (drop attack)
Partial (also called localization related, focal) Begins in one side of
brain Can spread to other
side
Types: Simple partial Complex partial Secondary generalized
+Revised Terminology and Concepts for Classification of Seizures/Epilepsies Generalized and focal seizures redefined
Generalized: “occurring in and rapidly engaging bilaterally distributed networks”
Focal (partial): occurring “within networks limited to one hemisphere and either discretely localized or more widely distributed”
Types of generalized seizures simplified, while focal seizures described in relation to manifestations
+Parts of a Seizure
Prodrome – changes in behavior, mood or feelings that may occur hours or days before a seizure
Aura - Symptoms correspond to the area of brain affected by the abnormal electrical activity. Most commonly seen with complex partial seizures.
Ictus- What is seen/felt during abnormal electrical activity
Postictal- What is seen/felt until the brain recovers to baseline
+Simple Partial Seizures
Sometimes called ‘auras’, is the first symptom of a seizure
No change in consciousness/awareness
What is seen/felt correlates with abnormal electrical activity in a part of the brain
+Examples of Simple Partial Seizures Sensory
Smells Sensations Visual changes Auditory symptoms
Autonomic Dilated pupils Queasy Stomach Skin flushing Pallor, etc.
Motor Unilateral jerking of face,
arm, and/or leg may spread from one
part of body to others May be unable to speak Can involve any part of
the body
Psychic Dejà-vu, jamais vu, out of
body experience Feelings of fear, anxiety,
happiness, depression
+Nursing Care During Seizure Simple PartialPromote safety
Guide patient to a safe place
Stay within arm’s reach
Stay calm
Observe the patient Speak calmly Assess awareness
Reassure
Time the seizure
Document event
+Complex Partial Seizures May start as simple
partial seizure or start suddenly
Awareness is impaired, though may be difficult to assess
May or may not hear, understand, see, respond or recall events during seizure
Duration: seconds to minutes
Automatisms: unusual and repetitive behaviors
Motor signs include: One or both sides of
body May be stiffening,
jerking, twitching, or absence of movement
May involve any part of the body including jaw, swallowing muscles, shoulders
Can spread from one body area to others
Post-ictal fatigue, confusion, sleepiness, headache
+Nursing Care During Complex Partial Seizure Promote safety
Guide patient away from potential dangers. Do not restrain patient
Patient may become combative if restrained If safe, let patient wander in an enclosed area
Assist patient to lie down if there is a loss of tone
Stay calm Observe behavior and time the seizure Observe post ictal state (patient may be confused
or tired) Reorient and reassure Stay with the patient until he/she returns to baseline
Document
+Secondarily Generalized SeizuresStarts in focal brain area then spreads
from one side to include the other side
That is, the seizure may start as a simple partial seizure or as a complex partial seizure
May spread slowly or rapidly to a generalized seizure, usually causing patient to fall
Electrographically, seizure involves both sides of brain
+Secondarily Generalized Seizures Eyes may roll back, may fall to ground or lean
over
Body becomes rigid (tonic) and then jerks (clonic)
May involve incontinence of bladder and/or bowel
May have forced head turn or eye deviation to side
May involve one side of body more than the other
Lasts 5 minutes or less
+Review of Partial Seizures
Video introducing partial seizures and what they look like from epilepsy.com
Understanding Partial Seizures (available 1/1/2014)
+Primary Generalized Seizures Involve both hemispheres at the onset
Types of primary generalized seizures:AbsenceMyoclonic TonicAtonicClonic Tonic-clonic
+Absence Seizures (Previously called petit mal)Sudden onset of behavioral arrest
May involve eyelid fluttering Duration: 5-30 seconds Usually occurs many times/day, difficult to
identify clinically because of brief duration
Returns to baseline almost immediately Possible anterograde or retrograde amnesia Hyperventilation and/or flashing lights may
precipitate seizures Classic EEG pattern
+Nursing Care: Absence Seizure
Promote safetyStay within
reach Falling unlikely
Stay calm
Observe behavior and time the seizure
Observe postictal behaviorUsually returns to
baseline immediatelyReorient
If photo-sensitive, avoid exposure to flashing lights or patternsDocument seizure
+Tonic-Clonic Seizures (previously called grand mal or major motor)Often begins with an ictal cry (loud
groan)
Body may be tonic – posturing or stiffening of all musclesPerson may appear as if not breathing
as chest muscles are rigid
Clonic movements – rhythmic jerking of head and extremities
May have forced eye deviation upward
+Tonic-Clonic Seizures
Duration: Generally lasts from seconds to 1-2 minutes Excessive salivation(collection of drooling) May involve tongue biting May involve bladder and/or bowel
incontinence May turn dusky or cyanotic Postictally, may have
Confusion Headache Muscle ache Sedation or fatigue for minutes to hours
+Nursing Care: Generalized Tonic-Clonic Seizure Stay calm
Promote safety Cushion fall if possible Support head
Loosen restrictive clothing
Place NOTHING between teeth
NO food or drink until able to swallow
Do not forcefully reposition or restrain the movements
+Nursing Care: Generalized Tonic-Clonic Seizure Promote Safety
Place patient in side-lying position as soon as possible Due to size or location of teenagers and adults,
may need to wait until seizure is subsiding before turning to side
Side-lying position promotes drainage of saliva from mouth May need to reposition head to keep airway clear In hospital, suctioning may help maintain airway,
especially if seizure is long
Observe behavior and time the seizure Assess for injury after the seizure is over
+Post Ictal Nursing Care: Tonic Clonic Seizure
Observe behavior May be sleepy,
confused, combative, difficulty talking, and unable to remember
If sleepy, continue in side-lying position to protect the airway
Gently restrain, if needed, to avoid injury
Reassure/reorient
Assess for injury
Monitor duration of postictal state Confusion may last
minutes Sleepiness may last
minutes to hours NPO until able to
swallow
Document
+Tonic SeizuresSustained bilateral stiffening or
posturing Usually brief but can last minutes May cause fall if standing or sitting
Sudden, very unpredictable Significant risk of injury due to loss of
protective reflexes, ie. cough, righting reflex
May have change in breathing patterns or look like not breathing or may appear pale or cyanotic
Can occur in clusters, sometimes along with other seizure types
+Atonic Seizures Atonic- also called “drop attacks”
Sudden loss of tone Drop of head with or without slight bending of knees Drop of head, trunk or entire body May fall backwards or forward if sitting or standing
Impaired awareness may be present but not discernible
Usually very brief, variable intensity (mild to forceful)
Significant risk of injury High risk for head lacerations, fractures, and other injuries Often require helmets and safety gear
+Myoclonic Seizures Very brief, fast muscle contractions of the head, arms,
legs, face, trunk and/or body Single jerk or clusters Unilateral or bilateral, can be specific muscle groups May cause loss of balance or fall May drop objects
Often occur when drifting to sleep or shortly after awakening
Impaired awareness may not be discernible
Clusters may precede a generalized tonic-clonic seizure
Some myoclonus may not be epilepsy-related
+Nursing Care: Tonic, Atonic and Myoclonic Seizures Stay calm Promote safety
Be sure safety gear is worn, if ordered Cushion fall if possible – support head Clear area of harmful objects or surfaces Loosen restrictive clothing Place NOTHING between teeth
There is no danger of the person swallowing their tongue
NO food or drink until able to swallow Turn to side-lying position if not able to protect
airway Do not forcefully reposition
+Nursing Care: Tonic, Atonic and Myoclonic SeizuresObserve behavior and time the
seizure/seizure cluster
Post ictal care: Observe behavior Reassure and re-orient Assess for injury NO food or drink until able to swallow Assess return to baseline state
Document
+Febrile Seizures
Frequency 2% - 5% of children
in United States
Most often in children aged: 3 mos-5 years
Associated with fever ≥ 101
Prolonged 13% > 10 minutes
5% > 30 minutes
A prolonged 1st febrile seizure, implies the next seizure will likely be prolonged
+ Febrile Seizures Simple febrile seizure
Generally lasts a few minutes and does not require treatment
Occurs within 24 hours of fever onset Usually generalized tonic clonic seizure No localizing deficits afterwards No prior history of non-febrile seizures No current intracranial infection No other neurological/developmental abnormalities No family history of non-febrile seizure
Complex febrile seizure Last > 15 minutes Have focal features or Recur within 24 hours
+Responding to Seizures: Summary of General First Aid
Stay calm/speak quietly
Time the seizure
Promote safety Help person to floor or
safe place, Prevent or cushion fall if
possible Support head Remove harmful objects Make comfortable
Maintain open airway Place nothing in
mouth between teeth
Keep onlookers away
Stay with person until seizure ends
Reorient and reassure patient
Assess frequently until back to baseline May need to sleep/rest Nothing to eat or drink until
able to swallow Assess for injury
+Review of Generalized SeizuresVideo introducing generalized seizures
and what they look like from www.epilepsy.com
Understanding Generalized Seizures
(available January 2014)
+TIPS FOR SEIZURE OBSERVATION AND RECORDINGWhen watching a seizure, observe:
What happens before, during and after the event
Write down what happened as soon as you can
Include as much information as possible
Download Tips for Seizure Observation and Recording by clicking here
(available January 2014)
© 2007 epilepsy.com A service of the Epilepsy Therapy Development Project
+Tips for Seizure Observation
What was person doing at time of event
Change in mood or behavior hours or days before
‘Warning’ or ‘aura’ shortly before event
Possible triggers or precipitants
When seizures occurs – date, time, duration
Before the Seizure
+Tips for Seizure Observation: During the Seizure
Change in awareness, alertness, confusion
Ability to talk and understand
Changes in thinking, remembering, emotions, perceptions
Sensations – changes in seeing, hearing, smells, tastes, feelings
Facial expression, pupil size, eye blinking or position, drooling
Changes in muscle tone
Movements – jerking or twitching, unable to move, body turning, falls
Automatic or repeated movements – lip smacking, chewing, swallowing, picking at clothes, rubbing hands, tapping feet, dressing or undressing
Walking, wandering, running
Changes in color of skin, sweating, breathing, loss of bladder or bowel control
PART OF BODY INVOLVED
+Tips for Seizure Observation
Response to voice or touch
Awareness of name, place, time
Memory for events
Ability to talk or communicate
Weakness or numbness
Changes in mood or how person acts
Fatigue, sedation
What Happens After Event
+ Tips for Seizure Observation
Duration of aura, seizure, after-effects or postictal phase
How long before person returns to normal activity
© 2007 epilepsy.com A service of the Epilepsy Therapy Development Project
Adapted with permission from the Comprehensive Epilepsy Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, 2006.
How Long It Lasted
+Post Ictal Nursing Care: All PatientsMonitor until returns to baseline Assess cognitive stateSpeak calmly and quietly –reorient and
reassureAllow to sleep if desiredDo not restrain: may cause aggression in
some people Assess for injury, postictal paralysis, mood
or behavior change Document
+When to Seek Medical Attention
History of seizure recurrence in person with rare or well-controlled seizures
Person with known epilepsy but occurrence of new seizure type
Persistent side effects of treatment bothersome to patient
+
When to Call for Emergency Help When seizures..
approach 5 minutes in duration or per patient’s seizure action plan
one seizure occurs after another
last longer than typical events
When person.. doesn’t return to
baseline in usual period of time
has first seizure has suspected injury is pregnant or diabetic
When observer is unsure or uncomfortable
+Injuries from Seizures
Immediate Lacerations Bruises Burns Head trauma Fractures Drowning/near
drowning
Delayed Fever Aspiration
pneumonia Subdural
hematomas Fractures (delayed
recognition) Change in seizures
or seizure emergencies
Seizure Assessment Algorithm
Reprinted with permission from the American Association of Neuroscience NursesReprinted with permission from the American Association of Neuroscience Nurses
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