(19) Seizures and Syncope

Seizure

a sudden and temporary alteration in brain function caused by massive, continuing electrical discharges in a group of nerve cells in the brain

convulsions

jerky muscle contractions from abnormal electrical discharges in a group of nerve cells in the brain

Epilepsy

chronic brain disorder characterized by recurrent unprovoked seizures

postictal state

You may likely find a patient in which phase of a seizure as an EMT?

grand mal seizure

The most common type of epileptic seizure, the generalized tonic-clonic seizure:

F

T or F?

All seizures result from epilepsy.

T

T or F?

As an EMT, your job is not to diagnose the type of seizure, but to:

• assess for and manage any life-threatening conditions

• manage airway, breathing, and circulation

• provide emergency care and reassurance to the pt.

Generalized seizures

involve both hemispheres of the brain and the reticular activating system

• typically results in loss of consciousness

• convulsions

Partial seizures

seizures related to abnormal activity in just one cerebral hemisphere

generalized

Which seizure is usually characterized by jerking muscle activity known as convulsions?

simple

Simple or complex partial seizure?

Pt remains awake and aware

complex

Simple or complex partial seizure?

Pt remains awake, but not aware

postictal state

Which seizure phase?

• the recovery phase

• AMS

Tonic phase

Which seizure phase?

• muscles become contracted and tense

• muscle rigidity

Clonic phase

Which seizure phase?

• Muscle spasms then alternate with relaxation, producing the typical violent and jerky seizure activity

Generalized tonic-clonic seizure (grand mal seizure)

This type of seizure:

• begins with abnormal electrical activity low in the cerebral cortex that spreads upward, affecting both cerebral hemispheres, and downward, affecting the reticular activating system (RAS).

• pt does not remain awake or aware

Reticular activating system (RAS)

The wake/sleep system that produces unresponsiveness during the seizure

Tonic

muscle stiffness and rigidity

Tonic-clonic

Loss of consciousness; muscle rigidity; convulsions, incontinence; postictal

Status epilepticus

• A continuous seizure activity lasting longer than 5 minutes

• Two or more sequential seizures without a full recovery of consciousness between seizures

Absence seizure

These seizures do not involve convulsive activity, but instead, they are characterized by a sudden cessation of conscious activity that involves a lack of vocalization (speaking) and a blank stare, beginning and ending abruptly, and lasting only 5 to

Myoclonic seizure

involves sporadic brief jerks of muscle groups on both sides of the body

• electrical shocks

Tonic seizure

characterized by a sudden onset of greatly increased muscle tone in the body, arms, or legs causing sudden muscular rigidity.

• reference to muscle tone

Atonic seizure

results in the total loss of muscle tone, resulting in loss of muscle strength

• The eyelids may droop, the head nods forward, and the loss of muscle strength causes the person to suddenly drop to the ground.

• frequently referred to as “drop attacks” or “drop seizures.”

Febrile seizure

defined as a seizure associated with a high fever without any evidence of intracranial infection or other definite cause of seizure

Simple partial seizure (focal onset aware seizure)

The patient is awake and aware that the seizure activity is occurring because the reticular activating system is not involved and only one cerebral hemisphere is involved.

Complex partial seizure

• involves only one cerebral hemisphere

• does not involve RAS, so the pt:

  • awake, but unaware

• usually starts in one small area in the temporal lobe or frontal lobe

• might begin as a simple partial seizure

• results in AMS

• mistaken for daydreaming

• seizure usually starts with a blank stare, followed by a random activity such as chewing, lip smacking, or rolling the fingers as if moving a marble between them, or wandering

Encourage him to go to the hospital for a checkup if the seizure is abnormal in any way.

You arrive on scene to a pt that is no longer seizing and is in a postictal state. They refuse emergency care and transportation as they are responsive. As an EMT, you might want to:

a.) Encourage him to go to the hospital for a checkup if the seizure is abnormal in any way.

b.) Allow him to refuse treatment without trying to change his mind.

c.) Force him to accept transport and/or treatment.

Syncope

a sudden and temporary loss of consciousness

• fainting

• temporary lack of blood flow to the brain and the brain is deprived of oxygen for a brief period

parasympathetic

A common cause of syncope is an overwhelming influence of the ________ nervous system that causes blood vessels to dilate throughout the body.

syncope

Dilating of the vessels in the body might result in:

Seizures

Incontinence (involuntary leakage or urine or stool) is common in:

Seizures or Syncope?