Epileptic Seizure

Patient presents to the Emergency Department with a severe right sided headache that started 2 hours ago. Patient is lying on bed, his wife sitting in a chair beside him. During initial assessment, he becomes increasingly confused and eventually has a generalized tonic-clonic seizure. During seizure the learner will need to perform basic protective measures (airway protection), and give benzos. Patient then will become post ictal. The learner will need to order basic tests (labs, accucheck), and CT scan which will show SAH. Learners will then need to give report to senior physician of presentation, results and suspected diagnosis.

 

Learning Objectives:

1. Perform detailed history (look for headache red flags)
a. Sudden onset, worst headache of life, neck pain, started during intercourse
2. Perform detailed neurological examination
a. Orientation, cranial nerves, strength, coordination, reflexes, sensitivity
3. Perform full physical examination
a. Neck exam (meningism)
4. Treatment for seizure
5. Initiation of adequate diagnostics
a. Labs, CT scan
6. Clinical reasoning
a. Able to report to the attending physician of their/her/his reasoning
a. Headache with red flags
7. Diagnosis and therapy of first epileptic seizure
8. Correct implementation of a focused assessment according to the ABCDE scheme with the associated therapeutic interventions in the postictal patient
9. Diagnosis and therapy for subarachnoid hemorrhage

Additional information

Learner

Nurse Practitioner, Paramedic, Physician, Physician Assistant

Contributor

Inselspital

Case Setting

Emergency Department

Specialty

Emergency medicine

Room Size

12×12

Language

English, German

Status

Not For Purchase