Patient might have a witnessed seizure or was found unconscious by family with tongue bite, Bladder/bowel incontinence.
EMS:
Checks Blood sugar
IV line and IV Fluids
ER:
Routine Labs, Blood Cultures if infection suspected
Oxygen
IV Fluids
IV Ativan 2mg PRN seizure
CT Head with out contrast
Phenytoin/Fosphenytoin IV loading dose of 15-20mg/Kg x 1 dose
Patient goes to the ICU for Status Epilepticus
Hospitalist:
Telemetry
Ask if patient is compliant or not with medications
Stop offending medications like Tramadol
Neuro-monitoring q 4hrs
NPO if altered mental status
Fall / Seizure / Aspiration precautions
UA, Urine Toxicology
Target treatment for possible cause of seizures-alcohol withdrawal, BZD withdrawal
Neurology evaluation-? LP
Dilantin/Valproic level if patient had break-through seizures while on treatment
MRI of Head for first time seizures
EEG if mental status changes
Driving restriction-Enter Driving License details and Fax form to Department of Transportation.
