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AED Protocol For First Time Seizure Episode

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16 views3 pages

AED Protocol For First Time Seizure Episode

Uploaded by

nikprov31
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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EWMSC AED PROTOCOL FOR THE MANAGEMENT OF FIRST TIME SEIZURES

Patient presents with first time seizure

Status epilepticus- YES


Was this a true seizure? N0
Consider: syncope, panic
manage accordingly O attacks, pseudoseizures
(based on history, eye witness)
O
YES

Assessment: BP, PR, RR, T, SpO2, Blood glucose

Treat accordingly if any of the following suspected


 Alcohol withdrawal/DT, meningitis, hypoglycaemia
 Eclampsia: MgSO4 4-6g IV stat followed by infusion of 1-2 g/hr and call O&G

All of the above excluded

Baseline investigations: CBC, urea and electrolytes, UPT (females of


childbearing age), ECG, CXR, urinalysis.

Toxicology and LP- only if clinically indicated

Indications for CT scan prior to discharge

• New focal neurological deficit


• Persistent altered mental status
• Fever or persistent headache
• Recent head trauma
• History of cancer or HIV infection
• Patients with focal or partial onset seizure
• History of alcohol abuse
• Anticoagulation or bleeding diathesis
• Past history of stroke or TIA

Patients whose follow up cannot be ensured


DISPOSITION RISK ASSESSMENT
(high risk if any HIGH; low risk if no HIGH and no MODERATE; otherwise moderate risk)

YES NO
Simple fit with full recovery HIGH
No neurological deficit HIGH
Normal initial investigations HIGH
History of/suspected alcoholism MOD
Poor social circumstances MOD
No responsible adult to supervise MOD
Unlikely to return for follow up MOD

HIGH MODERATE LOW

Admit Use clinical Discharge after 12 hr


judgement seizure watch
Important points to note

1. CT brain outpatient if not obtained while in AED ( within 1 week)


2. Neurology outpatient referral
3. Patients should be advised not to drive for one year following first time seizure
episode and should have a medical review before resuming
4. Patients should be advised not to go swimming alone
5. Patients should not be started on anti-epileptic drugs in the AED unless neurologist
consulted
6. EEG necessity should be determined after follow up in neurology clinic
7. Patients should be discharged in the care of a responsible adult
8. Document advice given
9. In known seizure disorder patients, CT brain should be considered for those
with new focal neurological deficits, significant trauma, persistent fever, new
pattern of seizure, or suspicion of HIV, infections or anticoagulation
10. In known seizure disorder patients, perform investigations as indicated;
discharge after 6-8 hours once seizure free.

Pulchan/De Freitas
2013

References

1. Turner S, Benger J. Guideline for the management of first seizure in the Emergency
Department [internet]. UK: Guidelines in emergency medicine network; Dec 2009
[cited Dec 9 2012]. Available from: http://www.collemergencymed.ac.uk/Shop-
Floor/Clinical%20Guidelines/default.asp

2. Dunn MJ, Breen DP, Davenport RJ, Gray AJ. Early management of adults with an
uncomplicated first generalized seizure. Emerg Med J [internet]. 2005 April [cited
2012 Dec 9]; 22 (4): [about 6 pages]. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726732/

3. ACEP Clinical Policies Committee and Clinical Policies Subcommittee for Seizures.
Clinical policy: critical issues in the evaluation and management of adult patients
presenting to the emergency department with seizures [internet]. Ann Emerg Med
[internet]. 2004 Jan [ctied 2012 Dec 9]; 43: [about 20 pages]. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726732/

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