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Ch. 20- Ch. 20- Seizures,Seizures, Dizziness, Dizziness,and Faintingand Fainting

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20.1 Causes and Types of 20.1 Causes and Types of SeizuresSeizures

Causes of SeizuresCauses of Seizures epilepsyepilepsy Acute head injury or strokeAcute head injury or stroke Low oxygen levels in the brainLow oxygen levels in the brain Drugs or alcoholDrugs or alcohol Derangements in the body’s chemistryDerangements in the body’s chemistry Trauma or other injury to the brain that causes scar formationTrauma or other injury to the brain that causes scar formation Reduced blood flow to the brainReduced blood flow to the brain Inflammation of the brain, usually caused by bacterial, viral, or Inflammation of the brain, usually caused by bacterial, viral, or

parasitic infectionparasitic infection Fever, usually in children 6 months to 3 years oldFever, usually in children 6 months to 3 years old Degeneration of the central nervous system, such as from multiple Degeneration of the central nervous system, such as from multiple

sclerosissclerosis Congenital brain defectsCongenital brain defects Brain tumorBrain tumor Hypoglycemia or hyperglycemiaHypoglycemia or hyperglycemia Severe burnsSevere burns Endocrine changes during pregnancy or menstruationEndocrine changes during pregnancy or menstruation

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PROGRESS CHECKPROGRESS CHECK

1. One of the most common causes of seizures is 1. One of the most common causes of seizures is __________.__________.

(epilepsy/head injury/stroke)(epilepsy/head injury/stroke)2. A seizure that causes a sudden cry or moan followed 2. A seizure that causes a sudden cry or moan followed

by muscle jerks and frothy saliva is a __________ by muscle jerks and frothy saliva is a __________ seizure.seizure.

(absence/tonic-clonic/simple partial)(absence/tonic-clonic/simple partial)3. An absence seizure is often mistaken for __________.3. An absence seizure is often mistaken for __________.(daydreaming/stroke/mental illness)(daydreaming/stroke/mental illness)4. Status epilepticus means the seizure has lasted 4. Status epilepticus means the seizure has lasted

__________ minutes. __________ minutes. (more than 5/10/more than 10)(more than 5/10/more than 10)5. Status epilepticus represents a dire medical 5. Status epilepticus represents a dire medical

emergency because the brain is deprived of _________.emergency because the brain is deprived of _________. (sodium/blood/oxygen)(sodium/blood/oxygen)

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VocabularyVocabulary

SeizureSeizure- An involuntary, sudden change in sensation, - An involuntary, sudden change in sensation, behavior, muscle activity, or level of consciousness that results behavior, muscle activity, or level of consciousness that results from irritation or overactivity of brain cellsfrom irritation or overactivity of brain cells

EpilepsyEpilepsy- A chronic brain disorder characterized by recurrent - A chronic brain disorder characterized by recurrent seizures not caused by acute problems, with or without loss of seizures not caused by acute problems, with or without loss of consciousnessconsciousness

Simple partial (Jacksonian) seizure- Simple partial (Jacksonian) seizure- A simple, partial A simple, partial seizure characterized by jerking in the fingers and toes; the seizure characterized by jerking in the fingers and toes; the jerking may spread to involve the entire arm or leg, but the jerking may spread to involve the entire arm or leg, but the victim stays awake and aware. It may progress to a generalized victim stays awake and aware. It may progress to a generalized tonic-clonic seizuretonic-clonic seizure

Complex partial (psychomotor) seizure- Complex partial (psychomotor) seizure- A seizure that A seizure that starts with a blank stare, then progresses into chewing or other starts with a blank stare, then progresses into chewing or other random, repetitive activity; the victim seems dazed random, repetitive activity; the victim seems dazed

Myoclonic seizure- Myoclonic seizure- A seizure characterized by sudden, brief, A seizure characterized by sudden, brief, massive muscle jerks that involve part or all of the bodymassive muscle jerks that involve part or all of the body

Atonic seizure- Atonic seizure- Also called a “drop attack,” a seizure in which Also called a “drop attack,” a seizure in which the legs of a child suddenly and temporarily collapse the legs of a child suddenly and temporarily collapse

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VocabularyVocabulary

status epilepticus status epilepticus A severe, prolonged seizure lasting A severe, prolonged seizure lasting longer than five minutes or a series of seizures that occur longer than five minutes or a series of seizures that occur without the victim’s regaining consciousness between without the victim’s regaining consciousness between themthem

generalized tonic-clonic (grand mal) seizure generalized tonic-clonic (grand mal) seizure A A convulsive seizure characterized by alternating muscle convulsive seizure characterized by alternating muscle rigidity and jerking, temporarily suspended breathing, rigidity and jerking, temporarily suspended breathing, and altered mental stateand altered mental state

absence (petit mal) seizure absence (petit mal) seizure A seizure characterized by A seizure characterized by a blank stare that lasts only a few seconds, most common a blank stare that lasts only a few seconds, most common in children; an absence seizure does not involve in children; an absence seizure does not involve convulsionsconvulsions

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Generalized Tonic-Clonic SeizuresGeneralized Tonic-Clonic Seizures

1. The 1. The auraaura, a peculiar “warning” sensation that lasts only a few , a peculiar “warning” sensation that lasts only a few seconds (it may be visual or auditory hallucinations, a peculiar seconds (it may be visual or auditory hallucinations, a peculiar taste in the mouth, or a painful sensation, for example)taste in the mouth, or a painful sensation, for example)

2. The 2. The tonic phasetonic phase lasts 15 to 20 seconds; the victim loses lasts 15 to 20 seconds; the victim loses consciousness, there is continuous muscular contraction, and consciousness, there is continuous muscular contraction, and the victim stops breathing.the victim stops breathing.

3. The 3. The hypertonic phasehypertonic phase lasts 5 to 15 seconds; there is extreme lasts 5 to 15 seconds; there is extreme muscular rigidity. muscular rigidity.

4. The tonic-4. The tonic-clonic phaseclonic phase lasts 30 to 60 seconds; muscular lasts 30 to 60 seconds; muscular rigidity and relaxation alternate rhythmically and in rapid rigidity and relaxation alternate rhythmically and in rapid succession, there is frothy saliva, and the victim may lose succession, there is frothy saliva, and the victim may lose bowel and bladder control.bowel and bladder control.

5. 5. Autonomic dischargeAutonomic discharge lasts for a few seconds; there is lasts for a few seconds; there is hyperventilation, salivation, and rapid heartbeat.hyperventilation, salivation, and rapid heartbeat.

6. During the 6. During the postseizure phasepostseizure phase, the victim lapses into a coma., the victim lapses into a coma.7. The 7. The postictal phase- commonly called the recovery postictal phase- commonly called the recovery

phasephase usually lasts 5 to 30 minutes, but occasionally usually lasts 5 to 30 minutes, but occasionally several hours; all muscles relax and the victim slowly several hours; all muscles relax and the victim slowly becomes responsive but remains exhausted.becomes responsive but remains exhausted.

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Assessment ConsiderationsAssessment Considerations

What the seizure was likeWhat the seizure was like Whether the victim has a history of seizuresWhether the victim has a history of seizures Whether the victim takes medication for seizuresWhether the victim takes medication for seizures How the seizure progressedHow the seizure progressed Whether the victim has suffered a head injuryWhether the victim has suffered a head injury Whether the victim uses drugs or alcoholWhether the victim uses drugs or alcohol Whether the victim has diabetes mellitus Whether the victim has diabetes mellitus

In performing a physical assessment, pay particular In performing a physical assessment, pay particular attention to the following:attention to the following:

Signs of injury to the head, tongue, or elsewhere on the bodySigns of injury to the head, tongue, or elsewhere on the body Signs of drug or alcohol abuse (such as alcohol on the breath or Signs of drug or alcohol abuse (such as alcohol on the breath or

needle tracks)needle tracks) The victim’s mental statusThe victim’s mental status FeverFever Presence of a Medic Alert tag or other identifying Presence of a Medic Alert tag or other identifying

medal or bracelet medal or bracelet

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First Aid Care for SeizuresFirst Aid Care for Seizures

1. Do not move the victim unless he or she is near a dangerous object that cannot 1. Do not move the victim unless he or she is near a dangerous object that cannot be moved. Otherwise, move objects away from the victim. Place padding under be moved. Otherwise, move objects away from the victim. Place padding under the victim’s head to prevent injury. the victim’s head to prevent injury.

2. Maintain an open airway.2. Maintain an open airway.3. Stay calm; if the victim is responsive, reassure him or her; reassure others who 3. Stay calm; if the victim is responsive, reassure him or her; reassure others who

are with the victim.are with the victim.4. Stay with the victim until the seizure has passed; if you need to get help, send 4. Stay with the victim until the seizure has passed; if you need to get help, send

someone else.someone else.5. Never try to force anything between the victim’s teeth, and never give the 5. Never try to force anything between the victim’s teeth, and never give the

victim anything by mouth.victim anything by mouth.6. Remove or loosen any tight clothing, especially around the neck; remove 6. Remove or loosen any tight clothing, especially around the neck; remove

eyeglasses.eyeglasses.7. Turn the victim on his or her left side with the face pointed downward so 7. Turn the victim on his or her left side with the face pointed downward so

secretions and vomitus can drain quickly out of the mouth and so the tongue secretions and vomitus can drain quickly out of the mouth and so the tongue will not fall back and block the airway.will not fall back and block the airway.

8. If the victim stops breathing, open the airway, remove anything that might 8. If the victim stops breathing, open the airway, remove anything that might impair breathing, and provide artificial ventilation. impair breathing, and provide artificial ventilation.

9. Do not try to restrain the victim unless he or she is in danger from objects that 9. Do not try to restrain the victim unless he or she is in danger from objects that cannot be moved.cannot be moved.

10. Keep the victim from becoming a spectacle; ask bystanders to leave.10. Keep the victim from becoming a spectacle; ask bystanders to leave.11. Following the seizure, reassure and reorient the victim; speak slowly and 11. Following the seizure, reassure and reorient the victim; speak slowly and

calmly in a normal tone of voice. Allow the victim to rest; help the victim calmly in a normal tone of voice. Allow the victim to rest; help the victim be as comfortable as possible. be as comfortable as possible.

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First Aid Care for Status First Aid Care for Status EpilepticusEpilepticus

*This is a dire medical emergency**This is a dire medical emergency*1. Place the victim on the floor or bed, away from 1. Place the victim on the floor or bed, away from

other furniture. Do not try to restrain the victim.other furniture. Do not try to restrain the victim.2. Clear and maintain the airway; turn the victim’s 2. Clear and maintain the airway; turn the victim’s

head sideways to prevent aspiration.head sideways to prevent aspiration.3. Administer artificial ventilation as needed; even 3. Administer artificial ventilation as needed; even

though it can be extremely difficult to administer though it can be extremely difficult to administer artificial ventilation to a seizing person, you artificial ventilation to a seizing person, you must do it—lack of oxygen during seizure must do it—lack of oxygen during seizure activity is the most serious threat to life.activity is the most serious threat to life.

4. Carefully monitor vital signs until emergency 4. Carefully monitor vital signs until emergency personnel arrive. personnel arrive.

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PROGRESS CHECKPROGRESS CHECK

1. An aura may involve a ____________. (hallucination/muscle 1. An aura may involve a ____________. (hallucination/muscle contraction/coma)contraction/coma)

2. The period in which a seizure victim loses consciousness 2. The period in which a seizure victim loses consciousness is the ____________ phase. (clonic/tonic/hypertonic)is the ____________ phase. (clonic/tonic/hypertonic)

3. During the ____________, the victim slowly recovers.3. During the ____________, the victim slowly recovers. (clonic phase/autonomic discharge/postictal stupor)(clonic phase/autonomic discharge/postictal stupor)4. During assessment of a seizure victim, pay particular 4. During assessment of a seizure victim, pay particular

attention to signs of injury to the ____________. attention to signs of injury to the ____________. (throat/head/back)(throat/head/back)

5. You should activate the EMS system if the victim has 5. You should activate the EMS system if the victim has more than ____________ seizure(s). (one/two/three)more than ____________ seizure(s). (one/two/three)

6. The primary goal in caring for the victim of status 6. The primary goal in caring for the victim of status epilepticus is ____________. (preventing injury/maintaining epilepticus is ____________. (preventing injury/maintaining airway/maintaining oxygenation)airway/maintaining oxygenation)

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DizzinessDizziness

Central vertigoCentral vertigo Dysfunction of the eye musclesDysfunction of the eye muscles Unequal pupil sizeUnequal pupil size Facial droopFacial droop

Labyrinthine vertigoLabyrinthine vertigo NauseaNausea VomitingVomiting Rapid, involuntary twitching of the eyeballRapid, involuntary twitching of the eyeball A whirling sensationA whirling sensation Pale, moist skinPale, moist skin Rapid heartbeatRapid heartbeat

First Aid CareFirst Aid Care1. Reassure the victim; help the victim get in a comfortable 1. Reassure the victim; help the victim get in a comfortable position and to move as little as possible.position and to move as little as possible.2. Conduct a thorough assessment to rule out any immediate 2. Conduct a thorough assessment to rule out any immediate life-threatening conditions.life-threatening conditions.3. Encourage the victim to see a physician. 3. Encourage the victim to see a physician.

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VocabularyVocabulary

Vertigo- Vertigo- DizzinessDizziness Central vertigo- Central vertigo- The least common type of vertigo The least common type of vertigo

(dizziness), which mimics a transient ischemic attack (dizziness), which mimics a transient ischemic attack or stroke; victims do not experience nausea, or stroke; victims do not experience nausea, vomiting, hearing loss, or a whirling sensationvomiting, hearing loss, or a whirling sensation

Labyrinthine vertigo- Labyrinthine vertigo- The most common kind of The most common kind of dizziness, caused by a disturbance in the inner ear dizziness, caused by a disturbance in the inner ear and characterized by nausea, vomiting, and a and characterized by nausea, vomiting, and a whirling sensationwhirling sensation

Syncope- Syncope- FaintingFainting

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FaintingFainting

1. If the victim has not yet fainted, prevent him or her from falling 1. If the victim has not yet fainted, prevent him or her from falling by having the victim sit down with head between the knees or by having the victim sit down with head between the knees or have the victim lie on the floor with legs elevated 8 to 12 have the victim lie on the floor with legs elevated 8 to 12 inches.inches.

2. If the victim has already fainted, keep the victim in a supine 2. If the victim has already fainted, keep the victim in a supine position; elevate the legs 8 to 12 inches.position; elevate the legs 8 to 12 inches.

3. Monitor for possible vomiting; loosen clothing that might 3. Monitor for possible vomiting; loosen clothing that might restrict free breathing.restrict free breathing.

4. Make a rapid assessment for any life-threatening condition that 4. Make a rapid assessment for any life-threatening condition that may have caused the fainting; initiate appropriate care.may have caused the fainting; initiate appropriate care.

5. Check for any injuries that may have occurred during the fall; 5. Check for any injuries that may have occurred during the fall; treat appropriately.treat appropriately.

6. Do not allow a person who has fainted to sit up immediately. 6. Do not allow a person who has fainted to sit up immediately. Instead, have the victim sit up slowly and gradually.Instead, have the victim sit up slowly and gradually.

7. Help the victim feel better by moving him or her to fresh 7. Help the victim feel better by moving him or her to fresh air or by putting a cool, damp cloth on the face. air or by putting a cool, damp cloth on the face.

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PROGRESS CHECKPROGRESS CHECK

1. The medical term for dizziness is ____________.1. The medical term for dizziness is ____________.(syncope/acidosis/vertigo)(syncope/acidosis/vertigo)2. The medical term for fainting is ____________.2. The medical term for fainting is ____________.(syncope/acidosis/vertigo)(syncope/acidosis/vertigo)3. The most serious kind of vertigo, ____________ vertigo, 3. The most serious kind of vertigo, ____________ vertigo,

causes symptoms like those of a stroke. causes symptoms like those of a stroke. (central/positional/labyrinthine)(central/positional/labyrinthine)

4. ____________ vertigo is caused by a disturbance in the 4. ____________ vertigo is caused by a disturbance in the inner ear.inner ear.

(Central/Positional/Labyrinthine)(Central/Positional/Labyrinthine)5. Fainting occurs when the ____________ is temporarily 5. Fainting occurs when the ____________ is temporarily

deprived of oxygen. deprived of oxygen. (heart/brain/liver)(heart/brain/liver)6. You can prevent someone from fainting by placing the 6. You can prevent someone from fainting by placing the

head ____________.head ____________.(at heart level/between the knees/lower than the feet)(at heart level/between the knees/lower than the feet)