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hour long seizure-what was this?



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Jul 05, 2009 02:49 AM

hour long seizure-what was this?


-New grad in the ER, a patient comes in by ambulance, in severe pain, with the left side of the body from the neck down convulsing. The pain was relieved with 10mg Valium, but convulsing did not cease. Pt was alert and orientated, able to communicate but distressed. Pain would return and was treated with ativan IV, 2.5mg Q 10 min, but unable to cease muscle spasms. Blood sugar 85 BP 150/90, CT scan negative for tumor, blood vessel obstruction. After 1 hr 10min, twitching stopped. Pt had left sided weakness (understandable) and was too sedated for home. Stayed the night and went home in the morning.
Everyone including physician and EMTs had not seen anything like this. What could it be? Parkininson's?


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11 Comments
No. 1
Old Jul 05, 2009, 02:53 AM

Default Re: hour long seizure-what was this?
I'd look for something abnormal on the spinal cord - a lesion or anything interfering with the descending motor pathways. Did they scan just the head or anything lower?
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No. 2
from jRN2be
Old Jul 05, 2009, 02:56 AM

Default Re: hour long seizure-what was this?
I know I am not a nurse, yet, but I was just wandering what the BMP or CMP looked like
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No. 3
from blue_yuina
Old Jul 05, 2009, 09:30 AM

Default Re: hour long seizure-what was this?
what should we do if someone on the street suddenly attack seizure?
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No. 4
from patwil73
Old Jul 05, 2009, 10:40 AM

Default Re: hour long seizure-what was this?
Could it be an overdose of dopamine antagonists (haldol, reglan, amoxapine) leading to EPS (extrapyramidal symptoms). I usually see it in the face and partial body, but it does take a while after getting medication to reverse?

Since the pain was relieved by valium and ativan (not normally used as pain meds) I assume that they calmed the spasms enough to decrease pain?

Just a wild guess here. . .

Pat
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No. 5
from grandee3
Old Jul 05, 2009, 12:06 PM

Default Re: hour long seizure-what was this?
I'm thinking EPS also.
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No. 6
from Roy Fokker
Old Jul 05, 2009, 01:01 PM

Default Re: hour long seizure-what was this?
Steven Grayson talks about an experience he had in his book.

It was about a 7 year old kid that kept sizing for hours on end despite continual adminstrations of Valium etc. Hours later, when the kid was in a super specialty peds hospital, the cause was determined to be some kind of encephalopathy due to eating bad food (apparently chicken with the bones as well!!)

cheers,
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No. 7
Old Jul 05, 2009, 01:44 PM

Default Re: hour long seizure-what was this?
I was thinking some sort of encephalopathy. Would that have shown up on the CAT scan?
Labs were unremarkable, the only med he used was methadone for pain.
Originally Posted by blue_yuina View Post
what should we do if someone on the street suddenly attack seizure?
Usually for a siezure you protect the patient from injury. Don't try to contain the patient or pu anything in the mouth. If possible position head to the side to prevent aspiration (true?). The wife knew about siezures but was very freaked out when the siezure didn't stop.
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No. 8
Old Jul 05, 2009, 02:46 PM

Default Re: hour long seizure-what was this?
My thought was: TIA, drug interaction/overdose, encephalopathy from tick/mosquito born illness (it's that time of the year). Was the person doing a lot of yard work, maybe had a reaction to weed killer, some kind of yard chemical? I saw a person who did that after the yard service sprayed their lawn with something. The OP's pt got a pretty hefty dose of Valium and was still seizing -- and with the pain, I guess was probably also getting IV pain meds pushed. Lots of things can cause seizures.

You can also fake them.
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No. 9
Old Jul 05, 2009, 04:55 PM

Default Re: hour long seizure-what was this?
If they had organophosphate poisoning, though, they'd have other systemic s/sx, like respiratory depression from the Ach inhibition's effects on the diaphragm, and would improve with Atropine.
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