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Altered Mental Status

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					Altered Mental Status
        Seizure and Syncope
Seizure
 Massive electrical discharge in a group of nerve
  cells in the brain
 Causes change in mental behavior
 Range from trancelike periods of inattention to
  unresponsiveness and jerky muscle spasms known
  as convulsions
 Common cause is epilepsy
    Chronic brain disorder characterized by

     recurrent seizures
Types of Seizures
   Generalized Tonic-Clonic Seizure (Grand Mal)
   Simple Partial Seizure
   Complex Partial Seizure
   Absence (Petit Mal ) Seizure
   Febrile Seizure
Generalized Tonic-Clonic Seizure
 Called Grand Mal Seizure
 Most common type of Epileptic Seizure
 Usually occurs in 4 stages
     Aura
     Tonic phase
     Clonic phase
     Postictal state
Aura
 Warning that seizure is going to begin
 Involves sensory perception
      Sound, abnormal twitch, anxiety, dizziness smell or
       odor, odd taste, visual disturbances, unpleasant feeling
       in the stomach
 Tell patient to let you know if he is going to seize
 Can have seizure without the Aura
Tonic Phase
 Patient becomes unresponsive and falls to the
  ground
 Typically follows Aura
 Muscles become contracted and tense
 Extreme muscle rigidity and arching back
Clonic Phase
 Convulsions
       Muscle spasms alternating with relaxation
       Produce violent and jerky seizure activity
   Loss of bladder and bowel control
   May bite tongue, lips, or mouth
   Breathing may be shallow or absent
   Usually last 1 to 3 minutes
Postictal State
 Recovery phase
 Complete unresponsiveness to confusion
  and disorientation
 Mental status improves over time
 Exhaustion and embarrassment
 May have a headache and hemiparesis
 Usually lasts 10 to 30 minutes
Emergency Care
   Maintain airway - Insert NPA if patient is unresponsive
   Never force anything into the patient’s mouth
   Big O’s With NR or begin positive pressure ventilation
   Position the patient
       Left lateral recumbent or supine and fully immobilized, but be
        ready for vomiting
   Suction as needed
   Assist breathing if seizure lasts longer than 5 minutes
   Protect the patient from hurting themselves
   Transport
Simple Partial Seizure
 Known as focal motor or Jacksonian motor seizure
 Jerky muscle activity in one area, arm, leg, or face
 Patient remains awake and aware of activity
 Can spread and become generalized tonic-clonic
  seizure
 Document where activity began and spread
Emergency Care
 Recurring problem transport may not be
  necessary
 First time seizure transport for further
  evaluation
 Contact medical control or follow protocol
Complex Partial Seizure
 Also known as psychomotor or temporal lobe seizure
 Usually starts with blank stare, followed by random
  activity such as lip smacking, chewing, or rolling the
  fingers
 Appears dazed, unaware of surroundings
 Mumbles or repeats certain word phrases
 Clumsy movements
 picks at or removes clothing
 Patient may struggle with you or show abrupt personality
  changes
Emergency Care
 Speak calm and reassuringly to the patient
 Guide patient away from hazards
 Stay with patient until he is aware of
  surroundings
 Will most likely refuse transport
 Contact medical control or follow protocol
Absence (Petit Mal) Seizure
 Most common in children
 Blank stare beginning and ending abruptly, only lasting a
  few seconds
 Rapid blinking, some chewing movements, lack of
  attention
 Unaware during seizure, awareness returns after seizure
  stops
 No emergency may be needed, but first time activity,
  medical evaluation should be recommended
Febrile Seizure
 Common in children between 6 months to 6 years
 Caused by high fever
 Affects approximately 5%
 Generalized seizure, short duration
 No emergency may be needed, but first time activity,
  medical evaluation should be recommended
 If seizure last longer than 15 minutes or recurs without
  recovery period, transport immediately
 Status epilepticus, true medical emergency
Scene Size-Up
   Assess scene for clues
   Look for any head injury
   Most commonly in postictal state upon arrival
   Do not hold patient down, guide movements
   Move objects away from patient
   Never place anything in mouth
   Be prepared to use AED if no pulse is found
Initial Assessment
 Assess A,B,C’s
 Status epilepticus - seizures that last longer than
  10 minutes with no period of responsiveness
  between them (true emergency)
Categories for Priority Transport
 Patient remains unresponsive after seizure
 Any inadequacy of A,B,C’s
 Second seizure occurs without a period of
  responsiveness
 Seizure last longer than 5 minutes
 Pregnant, history of diabetes, or trauma
 Seizure occurred in water
 Evidence of head trauma
Focused History/Physical Exam
 Postictal or altered mental status rapid
  assessment
 Assess head, pupils, look for medical alert
  tags
 Assess for fractures
 SAMPLE History
 Ongoing assessment
     Prepare for other seizures
Patient’s Medications
   Dilantin
   Phenobarbital
   Zarontin
   Tegretol
   Depakote
   Mysoline
   Clonopin
   Traxene
   Felbatol
Emergency Care
   Maintain airway - Insert NPA if patient is unresponsive
   Never force anything into the patient’s mouth
   Big O’s With NR or begin positive pressure ventilation
   Position the patient
       Left lateral recumbent or supine and fully immobilized, but be
        ready for vomiting
   Suction as needed
   Assist breathing if seizure lasts longer than 5 minutes
   Protect the patient from hurting themselves
   Transport
Syncope
 Fainting - lack of blood flow to the brain
 Can be confused with a seizure
 Difference
     Episode begins in a standing position
     Patient remembers feeling faint or lightheaded
     Patient becomes responsive almost immediately
      after becoming supine
     Skin is usually pale and moist
Emergency Care
   Ensure airway
   Consider c-spine
   Elevate legs if no spinal injury suspected
   NR. mask with 15 lpm. O2
   Assess vital signs
   Transport
   Consult medical control or follow protocol
   If patient is not responding appropriately consider
    altered mental status and treat accordingly

				
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posted:5/2/2013
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