Page 24 - Learnwell EVS
P. 24
1. A few symptomes and syndromes
Seizures
1
– Invo luntary m o vem ents o f cerebral o rigin (stiffness fo llo wed by clo nic m o vem ents),
acco m p anied by a lo ss o f co nscio usness, and o ften urinary inco ntinence (generaliz ed
to nic-clo nic seiz ures).
I t is im p o rtant to d istinguish seiz ures fro m „p seud o - seiz ures‟ ( e.g. in h y steria o r
tetany ) d uring which co nscio usness m ay ap p ear altered but is no t lo st.
– 2 p rio rities: sto p the seiz ures and d eterm ine the cause. In p regnant wo m en, eclam p tic
seiz ures require sp ecific m ed ical and o bstetrical care (see p age 2 5 ).
Initial treatment
During a seizure
– P ro tect fro m traum a, m aintain airway , p lace p atient in „reco very p o sitio n‟, lo o sen
clo thing.
– M o st seiz ures are quick ly self-lim ited . I m m ed iate ad m inistratio n o f an antico nvulsant
is no t sy stem atic. If generaliz ed seiz ure lasts m o re than 3 m inutes, use d iaz ep am to
sto p it:
Cdiahzeilpdarmen: 0 .5 m g/ k g p referably rectally witho ut exceed ing 1 0 m g.
1
I V ad m inistratio n is p o ssible ( 0 .3 m g/ k g o ver 2 o r 3 m inutes) , o nly if m eans o f
ventilatio n are available (A m bu bag and m ask ).
A d ults: 1 0 m g rectally o r slo wly I V .
I n all cases:
• D ilute 1 0 m g (2 m l) o f d iaz ep am in 8 m l o f 5 % gluco se o r 0 .9 % so d ium
chlo rid e.
• If co nvulsio n co ntinues, rep eat d o se o nce after 5 m inutes.
• In infants and eld erly p atients, m o nito r resp iratio n and blo o d p ressure.
• If co nvulsio n co ntinues after the seco nd d o se, treat as status ep ilep ticus.
The patient is no longer seizing
– L o o k fo r the cause o f the seiz ure and evaluate the risk o f recurrence.
– K eep d iaz ep am and gluco se available in case the p atient starts seiz ing again.
Status epilepticus
S everal d istinct seiz ures witho ut co m p lete resto ratio n o f co nscio usness in between o r
an uninterrup ted seiz ure lasting m o re than 1 0 m inutes.
– P ro tect fro m traum a, lo o sen clo thing, m aintain airway and ad m inister o xy gen as
required . 10% glucose in ch ild ren and
– Insert an IV line.
– A d m inister by slo w I V ( o ver 5 m inutes) : 5 m l/ k g o f
1 m l/ k g o f 50% glucose in ad ults.
– If d iaz ep am (see abo ve) has no t sto p p ed the seiz ure, co ntinue with phenobarbital by
IV infusio n:
C h ild ren und er 1 2 y ears: 2 0 m g/ k g ( m axim um 1 g) in 1 0 0 m l o f 0 .9 %
so d ium
ch lo rid e o r 5 % gluco se ad m inistered o ver 2 0 m inutes m inim um ( never exceed
1 m g/ k g/ m inute). I f necessary , a seco nd d o se o f 1 0 m g/ k g m ay be ad m inistered
(as
abo ve) 1 5 to 3 0 m inutes after the first d o se.
C hild ren o ver 1 2 y ears and ad ults: 1 0 m g/ k g (m ax. 1 g) in 1 0 0 m l o f 0 .9 %
Fsoor dreicutaml administration, use a syringe without a needle, or better, cut a nasogastric tube, CH8, to a length of
ch lo rid e o r 5 % gluco se ad m inistered o ver 2 0 m inutes m inim um ( never exceed
1 m g/ k g/ m inute). I f necessary , a seco nd d o se o f 5 to 1 0 m g/ k g m ay be
ad m inistered
(as abo ve) 1 5 to 3 0 m inutes after the first d o se.
1
Seizures
1
– Invo luntary m o vem ents o f cerebral o rigin (stiffness fo llo wed by clo nic m o vem ents),
acco m p anied by a lo ss o f co nscio usness, and o ften urinary inco ntinence (generaliz ed
to nic-clo nic seiz ures).
I t is im p o rtant to d istinguish seiz ures fro m „p seud o - seiz ures‟ ( e.g. in h y steria o r
tetany ) d uring which co nscio usness m ay ap p ear altered but is no t lo st.
– 2 p rio rities: sto p the seiz ures and d eterm ine the cause. In p regnant wo m en, eclam p tic
seiz ures require sp ecific m ed ical and o bstetrical care (see p age 2 5 ).
Initial treatment
During a seizure
– P ro tect fro m traum a, m aintain airway , p lace p atient in „reco very p o sitio n‟, lo o sen
clo thing.
– M o st seiz ures are quick ly self-lim ited . I m m ed iate ad m inistratio n o f an antico nvulsant
is no t sy stem atic. If generaliz ed seiz ure lasts m o re than 3 m inutes, use d iaz ep am to
sto p it:
Cdiahzeilpdarmen: 0 .5 m g/ k g p referably rectally witho ut exceed ing 1 0 m g.
1
I V ad m inistratio n is p o ssible ( 0 .3 m g/ k g o ver 2 o r 3 m inutes) , o nly if m eans o f
ventilatio n are available (A m bu bag and m ask ).
A d ults: 1 0 m g rectally o r slo wly I V .
I n all cases:
• D ilute 1 0 m g (2 m l) o f d iaz ep am in 8 m l o f 5 % gluco se o r 0 .9 % so d ium
chlo rid e.
• If co nvulsio n co ntinues, rep eat d o se o nce after 5 m inutes.
• In infants and eld erly p atients, m o nito r resp iratio n and blo o d p ressure.
• If co nvulsio n co ntinues after the seco nd d o se, treat as status ep ilep ticus.
The patient is no longer seizing
– L o o k fo r the cause o f the seiz ure and evaluate the risk o f recurrence.
– K eep d iaz ep am and gluco se available in case the p atient starts seiz ing again.
Status epilepticus
S everal d istinct seiz ures witho ut co m p lete resto ratio n o f co nscio usness in between o r
an uninterrup ted seiz ure lasting m o re than 1 0 m inutes.
– P ro tect fro m traum a, lo o sen clo thing, m aintain airway and ad m inister o xy gen as
required . 10% glucose in ch ild ren and
– Insert an IV line.
– A d m inister by slo w I V ( o ver 5 m inutes) : 5 m l/ k g o f
1 m l/ k g o f 50% glucose in ad ults.
– If d iaz ep am (see abo ve) has no t sto p p ed the seiz ure, co ntinue with phenobarbital by
IV infusio n:
C h ild ren und er 1 2 y ears: 2 0 m g/ k g ( m axim um 1 g) in 1 0 0 m l o f 0 .9 %
so d ium
ch lo rid e o r 5 % gluco se ad m inistered o ver 2 0 m inutes m inim um ( never exceed
1 m g/ k g/ m inute). I f necessary , a seco nd d o se o f 1 0 m g/ k g m ay be ad m inistered
(as
abo ve) 1 5 to 3 0 m inutes after the first d o se.
C hild ren o ver 1 2 y ears and ad ults: 1 0 m g/ k g (m ax. 1 g) in 1 0 0 m l o f 0 .9 %
Fsoor dreicutaml administration, use a syringe without a needle, or better, cut a nasogastric tube, CH8, to a length of
ch lo rid e o r 5 % gluco se ad m inistered o ver 2 0 m inutes m inim um ( never exceed
1 m g/ k g/ m inute). I f necessary , a seco nd d o se o f 5 to 1 0 m g/ k g m ay be
ad m inistered
(as abo ve) 1 5 to 3 0 m inutes after the first d o se.
1
