Acute, focal seizure part 4


• Scene – vitals, IV, 2mg versed IV, oxygen, CBG, 4mg Zofran
• En Route – monitor, EKG, vitals
• Hospital – unknown


• Response to treatment – patient responded to Versed and seizure stopped.


• Mark Shelton Paramedic Woodburn Ambulance


• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center

• Seizure disorder

Differential Diagnosis

• Seizure
• Postictal state
• Hypoglycemia
• Medication reaction/overdose
• CVA/stroke
• Thyrotoxicosis

Patient Workup

• With the past few months, patient developed seizure activity, prompting EMS intervention and eventual CT scan.
• Scan revealed a tumor on patient’s brain.
• Tumor was surgically removed, followed by chemotherapy and radiation.
• Patient’s husband described today’s seizure as less-violent than other, recent seizures.

Physical Exam

• Px in active seizure upon arriving; after Versed, seizure stopped within 1-2 minutes
• EKG – ST initially then SR
• GCS – 15
• CBG – 121

Key Points

• For educators consider the following:
• Discussion point: adult/geriatric patient presents with new onset seizure you should consider neoplasm.
• Discussion point: review of seizures, types, brain involvement, signs and symptoms.
• Discussion point: review postictal state and differentials.
• Discussion point: review of pharmacology particularly prehospital benzodiazepines and the patients at home medications.
• Discussion point: differentiating between carpal pedal spasms, contractures, and focal seizure activity.


• Gender: Female
• Age: 50 years
• Height: Not Available


• Temperature: Not Available
• Blood Pressure: 121/74
• Heart Rate: 122
• Respiratory Rate: 18
• Pulse Oximetry: 96% RA
Signs and Symptoms
Seizure activity


• PMH: Brain tumor, COPD, CA; former smoker.
• Allergies: Decadron, fentanyl
• Dispatch info: Female in seizure.


• Married, lives with spouse


• Dilantin, Keppra, levothyroxin

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