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Seizure

  • Common ddx

    • febrile seizure, drugs, trauma, EtOH withdrawal, hypoglycemia, convulsive syncope, seizure disorder, epilepsy, simple partial seizure, complex partial seizure
  • Serious ddx

    • electrolyte abnormality
    • increased ICP (brain tumor, hematoma, SAH)
    • meningitis
    • encephalitis
    • post-SAH vasospasm
    • eclampsia
    • status epilepticus
  • Labs

    • BMP, CBC, TSH, hCG
    • Utox, EtOH, med/drug levels
    • EKG if suspect cardio
    • head CT first if suspect increased ICP
    • LP if suspect meningitis
    • EEG followup
  • Tx

    • first: Ativan (lorazepam) 1-4 mg IV may repeat in 10-15min to max. 8mg
    • then: any combination of cerebyx (fosphenytoin) or dilantin (phenytoin) or phenobarbital
    • EEG outpt
  • Admission orders

    • Admit: Floor
    • Diagnosis: Seizure
    • Condition: Stable
    • Vital Signs: Routine
    • Allergies:
    • Nursing:
      • Neurologic checks q 1 hour for 2 hours, q 2 hours for 4 hours, and then q 4 hours
      • Capillary blood glucose q 4 hours
    • Diet: Regular
    • Activity: Fall and Seizure Precautions
    • Labs:
      • CBC, Chem, glucose, calcium, magnesium
      • EtOH level, UTox
      • antiepileptic medication levels
      • TSH
      • hCG
      • EKG if suspect cardio
      • head CT, noncontrast
      • Anticipate LP after CT
      • EEG in AM
      • MRI if inconclusive
    • IV: Heplock IV
    • Special: Neuro consult
    • Medications:
      • Diazepam 5-10 mg bolus at 5-minute intervals
      • Alternatives:
        • Lorazepam 2-5 mg bolus at 5-minute intervals
        • Midazolam at 0.2 mg/kg bolus followed by 0.75-10 ug/kg/min
    • Discharge
      • education
        • driving, swimming, climbing, other risky activities
        • med side effects, interactions
      • f/u antiepileptic drug levels
  • Other ddx

    • concussion, malignant hypertension, migraines, absence seizure, MI, arrhythmia
  • HPI

    • onset
    • triggering event
    • witnessed vs unwitnessed
    • loss of consciousness during seizure
    • description: convulsions, lip smacking, blank stare
    • duration, frequency
    • aura, sleepiness, postictal state
  • ROS

    • fever, weight loss
    • head trauma, headache
    • vision changes
    • cardio: chest pain, palpitations
    • pulm: dyspnea
    • GI: nausea, vomiting, diarrhea
    • neuro: paresthesia, muscle weakness
    • pregnancy status
  • PMH

    • seizure disorder, epilepsy, past seizures
    • recent or past SAH
    • PGynH if pregnant
  • FH

    • seizure dysorders, epilepsy
  • SH

    • EtOH
    • cocaine
    • amphetamines
  • Meds

    • new meds
    • meds that lower seizure threshold for those already with disorder
  • Allergies

  • Px

    • vitals: fever, BP
    • gen impression, mental status
    • head: trauma
    • eye: unequal pupils, papilledema
    • ENT: mucosal membrane
    • neck: thyroid
    • cardio: irregularity
    • pulm
    • abd
    • neuro: strength, bilateral grip, sensation, reflex, finger-to-nose, gait
    • examine body for occult trauma

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.