Emergency treatment of the seizuring patient

Abstract

When presented with a seizuring patient, preparation is very important. A systematic approach to history taking, examination and treatment can minimise errors in diagnosis and treatment in a stressful situation. The ABCs — airway, breathing and circulation — must be assessed first unless the patient presents having a tonic-clonic seizure, and any required corrective treatment applied. The cause of the seizure should be determined based on the history and clinical examination. In patients having a tonic-clonic seizure at the time of presentation, rectal diazepam may be given initially and a full examination delayed, otherwise a full clinical and neurological examination should be carried out, with further tests as required to reach a definitive diagnosis. Hypoglycaemia should be considered as a probable, extra-cranial, cause of seizure in young puppies, particularly those of small breeds. Once it is established that a true seizure has occurred (or is occurring), the appropriate treatment must be given, with diazepam or midazolam as the first line treatment. Phenobarbital and levetiracetam can both be used for emergency management of seizures and also for long-term anti-seizure medication. Propofol may be needed for patients that are resistant to benzodiazepines, phenobarbital and levetiracetam.