Bonner County EMS System Patient Care treatment Guidelines-Medical Emergencies and OB/GYNNeurologic Emergencies: Seizures-7020

SEIZURESSUBJECTIVE

Reported/ witnessed seizure activity

Previous seizure history Medical alert tag information Seizure medications History of trauma History of diabetes History of pregnancy

OBJECTIVE Decreased mental status Sleepiness Incontinence Observed seizure activity Evidence of trauma Unconscious Grand mal seizures are generalized

and associated with loss of consciousness

Focal seizures effect only a part of the body with no loss of consciousness

Jacksonian seizures start focal and become generalized

ASSESSMENT Head trauma Tumor Metabolic, hepatic or renal

failure Hypoxia Electrolyte abnormality Drugs, medications,

compliance Infection/fever Alcohol withdrawl Eclampsia Stroke Hyperthermia, Hypoglycemia

TREATMENT GUIDELINESR-EMR E-EMT A-AEMT P-PARAMEDIC **M-Medical Control

*****Higher level of providers are responsible for lower level treatments***

Initial Patient Contact (2000). Protect patient from further harm. Airway Management (4000). Consider Spinal Immobilization Procedure (9062). Oxygen Administration (9000); consider blow-by or 15L non rebreather mask. R If patient is actively seizing, transport to closest ALS receiving facility with ALS

intercept. Assist ALS with Cardiac Monitor and 12-lead EKG (9030) if indicated.

E Blood Glucose Analysis (9040).2

For glucose <60 administer 25 gm 50% Dextrose (D50) IV or 1 unit (1 mg) Glucagon IM if IV access is not established yet.2

Establish IV with NS, draw labs. Do not delay transport for IV access.2

A ALS indicated for ongoing or recurrent Seizures. For active or recurrent seizures administer 0.05 to 0.1 mg/kg Midazolam IV/IN/IM

(maximal single dose 2.5 mg); may repeat in 5 min x 2 for ongoing seizures. For patients without IV access, consider IN Mucosal Atomizer Device (MAD) administration with ½ of dose in each nares.

P **Contact Medical Control for status epilepticus and further orders.

Consider Oral Tracheal Intubation (9011)/ RSI (9013) for recurrent seizures.** M

2EMT providers may perform these procedures if credentialed with the appropriate OM.Pearls:Status epilepticus is defined as two or more successive seizures without a period of consciousness or recovery. This is a true emergency requiring rapid airway control, treatment and transport.Be prepared for airway problems and continued seizures.Assess possibility of occult trauma and substance abuse.Be prepared to assist ventilations especially if Midazolam is used.For any seizure in a pregnant patient, follow the OB/GYN Emergencies Guidelines (7080,7085).

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/16/2023 page 1 of 2

Bonner County EMS System Patient Care treatment Guidelines-Medical Emergencies and OB/GYNNeurologic Emergencies: Seizures-7020

Patients who are sedated or with new onset of seizures are not eligible for Refusal of Treatment.

QA 100% of patients with Status Epilepticus and field Intubations.

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/16/2023 page 2 of 2