Frequent seizures may need emergency treatment but if they are limited to small focal motor or sensory phenomena in an alert and talking patient, they pose little risk and may not need treatment that would threaten ventilation and respiration. A word with a neurologist may be helpful in deciding the tolerable seizure activity to allow.
Things to consider if seizures occur as a surprise:
- electrolyte disorder, esp low sodium
- withdrawal from meds or alcohol
- clot
- infection
- med side effect
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IV access is needed promptly. An oral or nasal airway may need to be inserted. If possible oximetry and cardiac monitoring should be organized. Supplemental O2, suction at the bedside, and IV anticonvulsant meds are indicated.. Ativan 4 mg IV over 2 - 5 minutes is the best ... can give up to 10 mg per hour. (For kids, calculate 0.1 mg/kg for the dose of ativan.) If the patient is on Dilantin draw a level and give the patient another bolus (usually 300 mg) right away (don't wait for the result to come back). If the Ativan and the Dilantin don't work give Phenobarb 100 mg IV at a time, the max dose is 20 mg/kg (1500 mg) in 24 hours ... if you get this far... start thinking about ICU. It is often a good idea to get a CT to look for the cause of the seizure...it is also a good idea to check the lytes, Ca++, MG++ and PO4 as well as a chest x-ray to look for aspiration-
Links: eMedicine; Neuroland; FERNE
Evidence Footnotes:
1. Working Group on Status Epilepticus. Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America's Working Group on Status Epilepticus. JAMA 1993;270:854-859.