Ch. 20- Seizures, Dizziness, and Fainting

1. Ch. 20- Seizures, Dizziness,and Fainting 1

2. 20.1 Causes and Types of Seizures • Causes of Seizures • epilepsy • Acute head injury or stroke • Low oxygen levels in the brain • Drugs or alcohol • Derangements in the body’s chemistry • Trauma or other injury to the brain that causes scar formation • Reduced blood flow to the brain • Inflammation of the brain, usually caused by bacterial, viral, or parasitic infection • Fever, usually in children 6 months to 3 years old • Degeneration of the central nervous system, such as from multiple sclerosis • Congenital brain defects • Brain tumor • Hypoglycemia or hyperglycemia • Severe burns • Endocrine changes during pregnancy or menstruation 2

3. PROGRESS CHECK 1. One of the most common causes of seizures is __________. (epilepsy/head injury/stroke) 2. A seizure that causes a sudden cry or moan followed by muscle jerks and frothy saliva is a __________ seizure. (absence/tonic-clonic/simple partial) 3. An absence seizure is often mistaken for __________. (daydreaming/stroke/mental illness) 4. Status epilepticus means the seizure has lasted __________ minutes. (more than 5/10/more than 10) 5. Status epilepticus represents a dire medical emergency because the brain is deprived of _________. (sodium/blood/oxygen) 3

4. Vocabulary • Seizure- An involuntary, sudden change in sensation, behavior, muscle activity, or level of consciousness that results from irritation or overactivity of brain cells • Epilepsy- A chronic brain disorder characterized by recurrent seizures not caused by acute problems, with or without loss of consciousness • Simple partial (Jacksonian) seizure- A simple, partial seizure characterized by jerking in the fingers and toes; the jerking may spread to involve the entire arm or leg, but the victim stays awake and aware. It may progress to a generalized tonic-clonic seizure • Complex partial (psychomotor) seizure- A seizure that starts with a blank stare, then progresses into chewing or other random, repetitive activity; the victim seems dazed • Myoclonic seizure- A seizure characterized by sudden, brief, massive muscle jerks that involve part or all of the body • Atonic seizure- Also called a “drop attack,” a seizure in which the legs of a child suddenly and temporarily collapse 4

5. Vocabulary • status epilepticus A severe, prolonged seizure lasting longer than five minutes or a series of seizures that occur without the victim’s regaining consciousness between them • generalized tonic-clonic (grand mal) seizure A convulsive seizure characterized by alternating muscle rigidity and jerking, temporarily suspended breathing, and altered mental state • absence (petit mal) seizure A seizure characterized by a blank stare that lasts only a few seconds, most common in children; an absence seizure does not involve convulsions 5

6. Generalized Tonic-Clonic Seizures 1. The aura, a peculiar “warning” sensation that lasts only a few seconds (it may be visual or auditory hallucinations, a peculiar taste in the mouth, or a painful sensation, for example) 2. The tonic phase lasts 15 to 20 seconds; the victim loses consciousness, there is continuous muscular contraction, and the victim stops breathing. 3. The hypertonic phase lasts 5 to 15 seconds; there is extreme muscular rigidity. 4. The tonic-clonic phase lasts 30 to 60 seconds; muscular rigidity and relaxation alternate rhythmically and in rapid succession, there is frothy saliva, and the victim may lose bowel and bladder control. 5. Autonomic discharge lasts for a few seconds; there is hyperventilation, salivation, and rapid heartbeat. 6. During the postseizure phase, the victim lapses into a coma. 7. The postictal phase- commonly called the recovery phase usually lasts 5 to 30 minutes, but occasionally several hours; all muscles relax and the victim slowly becomes responsive but remains exhausted. 6

7. Assessment Considerations • What the seizure was like • Whether the victim has a history of seizures • Whether the victim takes medication for seizures • How the seizure progressed • Whether the victim has suffered a head injury • Whether the victim uses drugs or alcohol • Whether the victim has diabetes mellitus In performing a physical assessment, pay particular attention to the following: • Signs of injury to the head, tongue, or elsewhere on the body • Signs of drug or alcohol abuse (such as alcohol on the breath or needle tracks) • The victim’s mental status • Fever • Presence of a Medic Alert tag or other identifying medal or bracelet 7

8. First Aid Care for Seizures 1. Do not move the victim unless he or she is near a dangerous object that cannot be moved. Otherwise, move objects away from the victim. Place padding under the victim’s head to prevent injury. 2. Maintain an open airway. 3. Stay calm; if the victim is responsive, reassure him or her; reassure others who are with the victim. 4. Stay with the victim until the seizure has passed; if you need to get help, send someone else. 5. Never try to force anything between the victim’s teeth, and never give the victim anything by mouth. 6. Remove or loosen any tight clothing, especially around the neck; remove eyeglasses. 7. Turn the victim on his or her left side with the face pointed downward so secretions and vomitus can drain quickly out of the mouth and so the tongue will not fall back and block the airway. 8. If the victim stops breathing, open the airway, remove anything that might impair breathing, and provide artificial ventilation. 9. Do not try to restrain the victim unless he or she is in danger from objects that cannot be moved. 10. Keep the victim from becoming a spectacle; ask bystanders to leave. 11. Following the seizure, reassure and reorient the victim; speak slowly and calmly in a normal tone of voice. Allow the victim to rest; help the victim be as comfortable as possible. 8

9. First Aid Care for Status Epilepticus *This is a dire medical emergency* 1. Place the victim on the floor or bed, away from other furniture. Do not try to restrain the victim. 2. Clear and maintain the airway; turn the victim’s head sideways to prevent aspiration. 3. Administer artificial ventilation as needed; even though it can be extremely difficult to administer artificial ventilation to a seizing person, you must do it—lack of oxygen during seizure activity is the most serious threat to life. 4. Carefully monitor vital signs until emergency personnel arrive. 9

10. PROGRESS CHECK 1. An aura may involve a ____________. (hallucination/muscle contraction/coma) 2. The period in which a seizure victim loses consciousness is the ____________ phase. (clonic/tonic/hypertonic) 3. During the ____________, the victim slowly recovers. (clonic phase/autonomic discharge/postictal stupor) 4. During assessment of a seizure victim, pay particular attention to signs of injury to the ____________. (throat/head/back) 5. You should activate the EMS system if the victim has more than ____________ seizure(s). (one/two/three) 6. The primary goal in caring for the victim of status epilepticus is ____________. (preventing injury/maintaining airway/maintaining oxygenation) 10

11. Dizziness Central vertigo • Dysfunction of the eye muscles • Unequal pupil size • Facial droop Labyrinthine vertigo • Nausea • Vomiting • Rapid, involuntary twitching of the eyeball • A whirling sensation • Pale, moist skin • Rapid heartbeat First Aid Care 1. Reassure the victim; help the victim get in a comfortable position and to move as little as possible. 2. Conduct a thorough assessment to rule out any immediate life-threatening conditions. 3. Encourage the victim to see a physician. 11

12. Vocabulary • Vertigo- Dizziness • Central vertigo- The least common type of vertigo (dizziness), which mimics a transient ischemic attack or stroke; victims do not experience nausea, vomiting, hearing loss, or a whirling sensation • Labyrinthine vertigo- The most common kind of dizziness, caused by a disturbance in the inner ear and characterized by nausea, vomiting, and a whirling sensation • Syncope- Fainting 12

13. Fainting 1. If the victim has not yet fainted, prevent him or her from falling by having the victim sit down with head between the knees or have the victim lie on the floor with legs elevated 8 to 12 inches. 2. If the victim has already fainted, keep the victim in a supine position; elevate the legs 8 to 12 inches. 3. Monitor for possible vomiting; loosen clothing that might restrict free breathing. 4. Make a rapid assessment for any life-threatening condition that may have caused the fainting; initiate appropriate care. 5. Check for any injuries that may have occurred during the fall; treat appropriately. 6. Do not allow a person who has fainted to sit up immediately. Instead, have the victim sit up slowly and gradually. 7. Help the victim feel better by moving him or her to fresh air or by putting a cool, damp cloth on the face. 13

14. PROGRESS CHECK 1. The medical term for dizziness is ____________. (syncope/acidosis/vertigo) 2. The medical term for fainting is ____________. (syncope/acidosis/vertigo) 3. The most serious kind of vertigo, ____________ vertigo, causes symptoms like those of a stroke. (central/positional/labyrinthine) 4. ____________ vertigo is caused by a disturbance in the inner ear. (Central/Positional/Labyrinthine) 5. Fainting occurs when the ____________ is temporarily deprived of oxygen. (heart/brain/liver) 6. You can prevent someone from fainting by placing the head ____________. (at heart level/between the knees/lower than the feet) 14