Seizures & Altered Mental Status : Seizures & Altered Mental Status By: Steve Coffin, NREMT-P
Month Overview : Month Overview Set 1- Seizures and AMS Powerpoint Lecture
Online Format
Set 2- Seizures and AMS Skills/Scenarios
In-House Training
Set 3- OB, Caring for a Mother and Neonate After Delivery
In-House Training
Objectives : Objectives Introduction to Seizures
Seizure Terminology
Types and Classification of Seizures
Treatment Considerations of Seizures
Causes of Altered Mental Status (AMS)
Treatment Considerations of AMS
Introduction : Introduction Physicians have identified 30 different types of Seizures.
Simplest means of classification is based off of terminology defining presentation.
General Types of Seizures : General Types of Seizures Partial Seizures
Generalized Seizures
Types of Partial Seizures : Types of Partial Seizures Simple Partial
Temporal Lobe
Jacksonian
Psychomotor
*Secondary Generalized*
Simple Partial : Simple Partial A localized seizure that occurs in one spot in the brain effecting one side of the body.
Commonly termed as Focal Mal
Presentation:
Jerking, muscle rigidity, spasms, head turning.
Sensory effects: vision, taste, smell, or touch.
Memory and emotional disturbances.
Simple Partial Seizures : Simple Partial Seizures Even though patients are not speaking or responding to EMS, the pt may be aware of all their surroundings and unable to communicate.
Presentation:
Jerking, muscle rigidity, spasms, head turning.
Sensory effects: vision, taste, smell, or touch.
Memory and emotional disturbances.
Complex Partial : Complex Partial Effect a larger portion of the brain than SP Seizures but still limited to one portion.
Presentation:
Does not effect consciousness but does effect awareness.
Pt is not aware and does not recall the incidents.
Memory and emotional disturbances.
Complex Partial Seizures : Complex Partial Seizures Emotional changes and outbursts.
Will walk, remove clothing, leave areas.
Hold conversations that aren't real.
Complex Partial: Temporal Lobe Seizures : Complex Partial: Temporal Lobe Seizures Primarily emotional changes.
Temporal lobe in the brain
S/S:
30 secs-1 minute
Loss of awareness and surroundings
Focal/Simple Partial changes
Emotional/Angry outbursts can include paranoia, anger, combative behavior.
Complex Partial: Jacksonian : Complex Partial: Jacksonian Rapid growth of electrical activity.
Involves a progression of electrical activity in the brain causing distal automation to move proximal.
Presentation
Distal Automation: numbness in fingers.
Automation moving proximal
Lip smacking, eye twitching and rapid eye movement, visual disturbances.
Lead into Generalized Seizures & LOC.
Partial: Absence/Petit Mal : Partial: Absence/Petit Mal A brief sudden lapse in awareness.
Commonly seen in children.
Presentation
Periods of time where the pt stares off in space and is not responsive.
*Atypical Absence
Similar to Absence seizures but add an automations.
Secondary Generalized Seizures : Secondary Generalized Seizures Aura effect from partial to generalized.
Partial seizures in distinct locations in the brain distribute and spread throughout the brain causing Generalized seizures.
ie: grandmal, tonic-clonic, myoclonic, etc.
Generalized Seizures : Generalized Seizures Effect of the body and loss of consciousness
“Grand Mal” seizures.
Specified into distinctive descriptions of physical activity and LOC.
Absence, Myoclonic, Tonic, Clonic, Tonic-Clonic, Atonic
Generalized Seizure: Absence : Generalized Seizure: Absence Brief LOC
Time loss or blank stare.
No physical activity, only mental time lapse.
Generalized Seizures: Myoclonic & Atonic : Generalized Seizures: Myoclonic & Atonic Loss of consciousness
Myoclonic: Sporadic, isolated muscle spasms, typically bilateral changes.
Atonic: loss of muscle tone and LOC.
Generalized Seizures: Tonic, Clonic, Tonic-Clonic : Generalized Seizures: Tonic, Clonic, Tonic-Clonic LOC plus one or all of the following:
Tonic: tensioning, muscle stiffness, rigidity
Clonic: convulsions
Tonic-Clonic: convulsions and tensioning, with LOC
Followed with postictal phase
Causes : Causes Epilepsy
Intoxication
Opiates
CO Poisoning
Intracerebral Hemorrhage
UTI
Sepsis Electrolyte Imbalance
Hypoglycemia
HHNK/DKA
CNS Depressants
Schizophrenia
Hepato-Renal Failure
Etc.
Altered Mental Status : Altered Mental Status Interactive Learning
Scenarios