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Fits |
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Precipitation of fits: In a known epileptic patient fits can be induced by starvation, fatigue, infection, stress, flickering lights, certain drugs (methohexitone, tricyclics, alcohol, enflurance) or menstruation.
Diagnosis: A grand mal epileptic convulsive episode : Aura —> Tonic phase —> Clonic phase —> Recovery Sudden loss of consciousness is accompanied by a rigid extended appearance and generalized jerking movements. Frequently they have urinary incontinence and may bite their tongue. There is often a slow recovery and the patient feels drowsy and dazed.
Management: ¨ Stop the procedure ¨ Clear the airway ¨ Protect the patient from harm and maintain airway ¨ Place in recovery position when possible and allow to recover Most fits resolve spontaneously within 5 minutes. If this does not happen, presume status epilepticus
Status epilepticus is recurrent seizures, occurring without recovery of consciousness between fits. This has risks of high mortality and morbidity if not controlled rapidly, especially in the elderly. ¨ Maintain airway and oxygenation ¨ Request help ¨ Control seizures with an anticonvulsant such as diazepam (10—20mg IV) ¨ Treat any hyperthermia as required ¨ Maintain hydration and electrolyte balance ¨ Chlormethiazole (10.8% solution) at a rate of 60—150 drops per minute as an IV infusion, up to 100ml ¨ IV bolus of up to 50ml of 20—50% dextrose ¨ Establish IV infusion of 0.9% saline and repeat the benzodiazepines if necessary ¨ If fits are not controlled it may be necessary to use a phenytoin infusion or induce anaesthesia with thiopentone and ventilate
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Most epileptic fits do not require active intervention as patients recover spontaneously in most cases. Ensure sensible positioning to prevent the patient from damaging themselves. |