Seizure ⚡️

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🧠 Differential

  • Epileptic seizure (known epilepsy?)
  • Alcohol withdrawal (DTs)
  • Metabolic: Na, Ca, glucose, urea
  • Structural: tumour, bleed, infection
  • Non-epileptic: pseudoseizure

📞 Immediate Actions

  • A–E assessment
  • Protect airway & patient (side position, clear surroundings)
  • Check vitals, oxygenate, consider suction
  • IV access, bedside glucose
  • Urgent bloods: U&E, glucose, calcium, toxicology, LFTs
  • ECG

🚑 Ongoing Seizure (Status Epilepticus)

  • Defined as seizure >5 min or recurrent seizures without recovery
  • Initial rescue therapy: Midazolam 5mg intranasal or buccal if no IV access
  • 3 minutes later: Midazolam 5mg intranasal or buccal again if still seizing
  • 2 minutes later: Lorazepam 2mg IV slowly over 2 mins
  • 2 minutes later: Lorazepam 2mg IV again if still seizing
  • 2 minutes later: Levetiracetam 60mg/kg IV (max 4500mg) over 10 minutes
  • If still seizing: proceed to RSI with Propofol or Phenobarbital and ICU support
  • Throughout: ensure airway protection, cardiac monitoring, glucose and electrolytes

🔍 Post-Ictal Workup

  • CT Brain if first seizure or focal neurology
  • Consider LP if infection suspected
  • Drug/alcohol screen if relevant
  • Collateral history from witnesses

⚠️ Red Flags

  • GCS < 8 after seizure
  • Prolonged post-ictal state >30–60min
  • Focal neurology or trauma signs
  • Multiple seizures or status epilepticus

📋 Plan

  • Seizure terminated → Neuro Obs 1-hrly until GCS 15
  • Antiepileptic drug (AED) restart if known epilepsy
  • Neurology referral for new seizures
  • Driving advice: no driving for minimum 6 months

Note Template

Ready-to-use clinical note structure

🕒 20 / 11 / 2025 — 22:40

ATRP re: seizure
Patient: [age] [sex]
Admission Dx: [reason for admission]
PMHx: [epilepsy, brain injury, metabolic disorders]

🧾 Hx:
• Type and duration of seizure
• Witnessed activity and post-ictal state
• Previous seizure history and medications
• Triggers: infection, non-compliance, alcohol

🩺 Exam:
• ABCDE assessment
• Vitals: HR __ BP __ RR __ Temp __ SpO₂ __
• Neurological exam: GCS, focal deficits
• Signs of trauma or tongue biting

📋 Impression:
Likely seizure type: [generalised / focal / status epilepticus]

📌 Plan:
• Ensure airway patency and oxygenation
• Check glucose and correct hypoglycaemia
• IV/IM benzodiazepines if active seizure
• Bloods: electrolytes, anticonvulsant levels
• Neuroimaging if first seizure or focal signs
• Review and optimise anti-epileptic drugs
• Monitor for recurrence and escalate if needed

👤 [Your Name], [Role]
IMC: _______
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