Algorithms for Emergency Medicine - Fits and Seizures

Flashcards covering emergency management, differential features, drug protocols, and indications for urgent CT following fits and seizures.

Default position in seizure vs. pseudo seizure differentiation

Treat as a possible seizure if unable to distinguish between a seizure and a pseudo seizure.

Babinski sign in pseudo seizure

Absent in a pseudo seizure.

Tongue biting in pseudo seizure

Tongue biting does not occur in a pseudo seizure, though patients have been known to bite the mucosa of the cheek.

First-line Diazepam dosage (emergency seizure control)

$10-20\,\text{mg}$ per rectum.

First-line Midazolam dosage (emergency seizure control)

$10\,\text{mg}$ buccal.

First-line Lorazepam dosage (emergency seizure control)

$4\,\text{mg}$ IV.

First-line benzodiazepine repeat interval

Can be repeated after $10-15\,\text{minutes}$ if seizure continues.

Second-line drug therapy for prolonged seizure

Phenytoin $15\,\text{mg/kg}$ at $100\,\text{mg/minute}$.

Third-line Propofol regimen for prolonged seizure

$1-2\,\text{mg/kg}$ bolus, then titrate to effect ($2-10\,\text{mg/kg/hour}$).

Third-line Midazolam regimen for prolonged seizure

$0.1-0.2\,\text{mg/kg}$ bolus, then titrate to effect ($0.05-0.5\,\text{mg/kg/hour}$).

Third-line Thiopentone regimen for prolonged seizure

$3-5\,\text{mg/kg}$ bolus, then titrate to effect ($3-5\,\text{mg/kg/hour}$).

Todd's paresis

An associated focal neurological deficit following a seizure that serves as an indication for urgent CT.

Indications for urgent CT following seizure

Post head injury, associated sudden onset or persistent headache, associated focal neuro deficit (Todd's paresis), history of cancer, HIV, or stroke, associated fever, focal onset, patient is anticoagulated, or patient will not be compliant with follow-up.