Convulsion management

Posted on: Sunday, June 10th, 2018 @ 1:46 AM - By: Mohemet - Seen 214 Times

Siezure is an abnormal electrical discharge in the brain. It can manifest as:

  • disturbance in the level of consciousness
  • abnormal body movement (convulsion)
  • sensory disturbance
  • abnormal behavior
  • autonomic disturbance (tachycardia, hypertension, salivation)

So convulsion is abnormal body movement -A convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body-. However the term convulsion is sometimes used as a synonym for seizure.


What to do:

when receiving a patient is convulsing immediately start to do ABC:

  • A: ensure airway patency, open mouth, remove any foreign body, do suction if there is secretions, if needed put airway tube.
  • B: check for breathing. is the patient breathing normally, if there is hypoxia give oxygen, if not breathing start giving breaths by abmubag.
  • C: check for pulse and deal accordingly

if still there is convulsion then give Diazepam amp 0.3-0.5mg/kg diluted with NS. Diazepam can be repeated every 3-5 minutes for upto 3 times if the patient continued to have convulsion.

How to prepare diazepam: Diazepam is 10mg/2ml (1ml=5mg). Dilute with 8ml NS it becomes 10mg in 10mml (1mg/ml). The dose is 0.5ml/kg, so for each kg give 0.5ml, e.g. for 10kg child give 5cc slowly.
  • if convulsion is not controlled after 3 doses of diazepam start giving Phenytoin 15-20mg/kg inside 50ml NS over 30 minutes
Be aware: Phenytoin should be put within NS only, it should not be given in GS or GW!

History and examination:
Having the siezure controlled, now it’s time to take a full history and perform a thorough examination. Ask about type of siezure (generalized or focal, tonic-clonic, tonic, atonic or myoclonic), duration of siezure, No. of attacks per 24 hr, is it first time or there is previous history, is there family history of the same condition? Ask about any condition that may result in siezure e.g fever, diarrhea and vomiting, drug poisoning, head trauma.

Examination:
Do complete physical examination, do meningeal signs to know is patient having menigitis? if feverish, search for the cause of fever.

Investigations:
RBS, CBC, CRP,  Serum electrolytes, Serum calcium, GUE, CSF examination if meningitis is suspected, Brain CT scan if history of head trauma or suspecting intracranial insult.

Treatment:
Along with control of convulsion, treat the underlying cause. For example if it was due to fever: give antipyretic, try to find the cause of fever and give antibiotics accordingly, if meningitis suspected give antimenigeal treatment.

Filed under: Featured / Nervous system