You should take these steps to care for seizure patients
The following steps are taken for seizure patients who present to the ED at St. Joseph’s Hospital & Medical Center in Phoenix.
- For patients having active seizure activity involving tonic/clonic movement:
Safety precautions are taken, including using side rails and having suction available. The airway is maintained and oxygen is provided, usually with a 100% nonrebreather mask. An intravenous line access is established, blood is drawn for labs, and glucose levels are checked. The seizure is controlled with lorazepam, continuing with dilantin afterward. For patients in status epilepticus, treatment could include other medications, such as propofol. The patient is monitored for cardiac and oxygen saturation.
- For patients with a first-time seizure:
Labs include complete blood count (CBC) with comprehensive metabolic profile (SMA-20 including calcium and magnesium), toxicology panel with urine and blood screens, and blood to be held for coagulation studies and blood typing, due to the possibility of cerebral bleed that would require coagulation studies or blood transfusion. A basic head without contrast computed tomography (CT) scan is given. Underlying causes are treated, either metabolic or toxic. A neurology consult occurs, with a neurosurgical consult if the CT is positive. A loading dose of dilantin is given. The patient is admitted if the underlying cause necessitates admission or if no underlying cause is found.
- For patients with a seizure history:
Labs include a CBC with basic metabolic panel and drug levels if a patient’s medications are known. When lab results are back, subtherapeutic drug levels are treated. If levels are within normal limits, the patient’s neurologist or primary care physician is contacted. If neither is available, a neurology consultation is given. The patient is discharged home as long as support mechanisms are in place to ensure that the patient will not be alone and will follow up with a neurologist.