Seizure Disorders

Seizure DisordersSeizure Disorders

Albemarle County Public Albemarle County Public SchoolsSchools

What is a Seizure?What is a Seizure?

An event in which there is a temporary change in An event in which there is a temporary change in behavior resulting from a sudden, abnormal behavior resulting from a sudden, abnormal burst of electrical activity in the brain or change burst of electrical activity in the brain or change in the normal brain waves. in the normal brain waves.

Generalized seizure:Generalized seizure: occurs when the disturbance occurs when the disturbance affects the entire brain.affects the entire brain.

Partial seizure:Partial seizure: occurs when the disturbance occurs when the disturbance affects only one area of the brain. affects only one area of the brain.

Generalized Seizures: Tonic-ClonicGeneralized Seizures: Tonic-Clonic

Usually lasts 2 – 3 minutes Usually lasts 2 – 3 minutes May have aura or warning before May have aura or warning before Eyes roll upwardEyes roll upward Loss of consciousness and falls to ground Loss of consciousness and falls to ground Becomes rigid as the muscles tightenBecomes rigid as the muscles tighten Followed by jerking movements of the entire Followed by jerking movements of the entire

body as muscles undergo rhythmic tightening body as muscles undergo rhythmic tightening and relaxing and relaxing

May become incontinent, breathing may be May become incontinent, breathing may be shallow or stop briefly, person is usually drowsy shallow or stop briefly, person is usually drowsy afterwardsafterwards

Generalized Seizures: Absence or Petit MalGeneralized Seizures: Absence or Petit Mal

Brief loss of consciousness with little or no Brief loss of consciousness with little or no alteration in muscle tonealteration in muscle tone

May go unnoticedMay go unnoticed May include “blank stare” for 5 to 10 secondsMay include “blank stare” for 5 to 10 seconds May drop an object as lose muscle toneMay drop an object as lose muscle tone May have minor movements such as lip May have minor movements such as lip

smacking or twitchingsmacking or twitching Inability to recall what happened afterwardsInability to recall what happened afterwards

Generalized Seizures: AtonicGeneralized Seizures: Atonic

Sudden, momentary loss of muscle toneSudden, momentary loss of muscle tone May or may not lose consciousnessMay or may not lose consciousness May be mild such as brief head drop or May be mild such as brief head drop or Severe: fall to ground, lose consciousness Severe: fall to ground, lose consciousness

briefly, then get up as though nothing briefly, then get up as though nothing happened happened

Partial Seizures: SimplePartial Seizures: Simple

Manifestations depend on area of brain Manifestations depend on area of brain affected. affected.

May or may not lose consciousness or be May or may not lose consciousness or be aware of seizure.aware of seizure.

Example: eyes or eyes and head may Example: eyes or eyes and head may turn to one side and the arm on that side turn to one side and the arm on that side may be extended with fingers clenched. may be extended with fingers clenched.

Partial Seizures: ComplexPartial Seizures: Complex

Most common type.Most common type.

May begin with aura such as odd taste or May begin with aura such as odd taste or smell and/or visual hallucinations.smell and/or visual hallucinations.

May cry out then suddenly become May cry out then suddenly become unaware of surroundings and unable to unaware of surroundings and unable to respond.respond.

May become limp or stiff and appear May become limp or stiff and appear dazed, confused and apathetic. dazed, confused and apathetic.

Basic Seizure ManagementBasic Seizure Management

Protect studentProtect student Observe:Observe: Note which parts of body Note which parts of body

involved and duration.involved and duration. Get medical assistanceGet medical assistance when needed:when needed: A A

series of seizures without regaining series of seizures without regaining consciousness or a seizure lasting longer consciousness or a seizure lasting longer than 5 minutes can be a medical than 5 minutes can be a medical emergency. emergency.

Managing a Seizure in the School Managing a Seizure in the School SettingSetting

Each student with a known Each student with a known seizure disorder should have a seizure disorder should have a Seizure Action Plan* on file in Seizure Action Plan* on file in the school health office. the school health office.

Procedure for Managing a SeizureProcedure for Managing a Seizure

1.1. If student has a known seizure disorder, follow plan.If student has a known seizure disorder, follow plan.2.2. Remain calm – seizure can’t be stopped once it starts.Remain calm – seizure can’t be stopped once it starts.3.3. Have an adult monitor the student.Have an adult monitor the student.4.4. Note exact time of onset.Note exact time of onset.5.5. Put on gloves, if available.Put on gloves, if available.6.6. Place student on side. If possible, put something soft Place student on side. If possible, put something soft

under student’s head.under student’s head.7.7. Do not place anything in student’s mouth.Do not place anything in student’s mouth.8.8. Document: time seizure began, body part involved and Document: time seizure began, body part involved and

any movement from one part to another, type of any movement from one part to another, type of movements of head, face, arms.movements of head, face, arms.

Call Emergency Medical Services Call Emergency Medical Services 911 if:911 if:

Student stops breathingStudent stops breathingThere is evidence of injuryThere is evidence of injuryStudent is diabetic or pregnantStudent is diabetic or pregnantSeizure lasts more than 5 minutesSeizure lasts more than 5 minutesPupils are not equal in size after seizurePupils are not equal in size after seizureStudent cannot be awakened after seizureStudent cannot be awakened after seizureStudent vomits continuously after seizure Student vomits continuously after seizure This is student’s first seizureThis is student’s first seizure

After SeizureAfter Seizure

1.1. Monitor breathing. Check position of head and tongue. Monitor breathing. Check position of head and tongue.

2.2. Determine level of awareness. Note if alert, confused, Determine level of awareness. Note if alert, confused, drowsy, etc.drowsy, etc.

3.3. Determine if student is able to move limbs. Determine if student is able to move limbs. 4.4. Check for injuries and provide care if needed. If Check for injuries and provide care if needed. If

student remains unconscious maintain open airway student remains unconscious maintain open airway and continue to assess.and continue to assess.

5.5. Check for loss of control of urine and stool.Check for loss of control of urine and stool.6.6. Provide comfort measures.Provide comfort measures.7.7. Document length of seizure and what happened during Document length of seizure and what happened during

and after. and after. 8.8. Call or have someone call parents promptly. Call or have someone call parents promptly.

Rectal DiazepamRectal Diazepam

Some students with known seizure Some students with known seizure disorders have a medication prescribed by disorders have a medication prescribed by a doctor to be administered if the seizure a doctor to be administered if the seizure lasts more than 5 minutes. This must be lasts more than 5 minutes. This must be in the student’s care plan with both parent in the student’s care plan with both parent and physician signatures. and physician signatures.

Procedure for Administering Rectal Procedure for Administering Rectal Diazepam (Diastat) at SchoolDiazepam (Diastat) at School

1.1. Don gloves.Don gloves.2.2. Obtain assistance of other adult, if possible.Obtain assistance of other adult, if possible.3.3. Remove protective cover from the medication syringe and lubricate Remove protective cover from the medication syringe and lubricate

the rectal tip with the jelly in the package.the rectal tip with the jelly in the package.4.4. Turn student on side (left preferably) facing you. Bend the upper Turn student on side (left preferably) facing you. Bend the upper

leg forward and separate the buttocks to expose the rectum.leg forward and separate the buttocks to expose the rectum.5.5. Gently insert the syringe tip into the rectum. The rim should be Gently insert the syringe tip into the rectum. The rim should be

snug against the opening. Slowly count to three while gently snug against the opening. Slowly count to three while gently pushing in the plunger.pushing in the plunger.

6.6. Count to 3 again before removing. Hold the buttocks together and Count to 3 again before removing. Hold the buttocks together and count to 3 again. count to 3 again.

7.7. Keep student on side and note the time. Keep student on side and note the time. 8.8. 9-1-1 must be called when diastat is given at school. 9-1-1 must be called when diastat is given at school. 9.9. Observe for side effects.Observe for side effects.10.10. Remove gloves and wash hands. Remove gloves and wash hands.

See following slides for simplified pictorial instructionsSee following slides for simplified pictorial instructions

Diastat* InstructionsDiastat* Instructions Delegate call to 911.Delegate call to 911. Check orders and care plan. Check orders and care plan. Clear area of students and on lookers.Clear area of students and on lookers. Put on gloves.Put on gloves. If student is in a wheelchair or car/bus seat child to If student is in a wheelchair or car/bus seat child to

ground.ground. Follow instructions on following slides.Follow instructions on following slides. Call or delegate call to parents after diastat is Call or delegate call to parents after diastat is

administeredadministered..

**Diastat information obtained from Valeant Pharmaceutical and is included here with permission for Diastat information obtained from Valeant Pharmaceutical and is included here with permission for educational purposes only. See educational purposes only. See http://www.diastat.com/HTML-INF/index.htmhttp://www.diastat.com/HTML-INF/index.htm for additional for additional information. information.

Diastat InstructionsDiastat Instructions

1.1. Put student on side Put student on side he/she where can’t fall.he/she where can’t fall.

2.2. Get the diastat kit.Get the diastat kit.

3.3. Get syringe. Note: Seal Get syringe. Note: Seal pin is attached to cap. pin is attached to cap. Check dose in dial Check dose in dial window.window.

Diastat InstructionsDiastat Instructions

4.4. Push up with thumb and Push up with thumb and pull to remove cap from pull to remove cap from syringe. Be sure seal syringe. Be sure seal pin is removed.pin is removed.

5.5. Lubricate rectal tip with Lubricate rectal tip with lubricating jelly.lubricating jelly.

6.6. Turn student on side Turn student on side facing you.facing you.

Diastat InstructionsDiastat Instructions

7.7. Bend upper leg forward Bend upper leg forward to expose rectum.to expose rectum.

8.8. Separate buttocks to Separate buttocks to expose rectum.expose rectum.

9.9. Gently insert syringe tip Gently insert syringe tip into rectum. Rim should into rectum. Rim should be snug against rectal be snug against rectal opening.opening.

Diastat InstructionsDiastat Instructions10.10. Slowly count to 3 while gently Slowly count to 3 while gently

pushing plunger until it stops.pushing plunger until it stops.

11.11. Slowly count to 3Slowly count to 3 before removingbefore removing syringe.syringe.

12.12. Slowly count to 3 Slowly count to 3 while holding while holding buttocks together.buttocks together. 13.13. Keep student on sideKeep student on side facing you, note timefacing you, note time and continue to observe.and continue to observe.

Diastat InstructionsDiastat Instructions

Disposal Instructions:Disposal Instructions:For AcuDial: After 14a For AcuDial: After 14a

put syringe in box or put syringe in box or bag and give to bag and give to rescue squad rescue squad personnel.personnel.

For 2.5 mg syringe put For 2.5 mg syringe put syringe in box or bag syringe in box or bag and give to rescue and give to rescue squad personnel. squad personnel.

How to Administer Diastat VideoHow to Administer Diastat Video

For a video demonstration on administering For a video demonstration on administering Diastat go to: Diastat go to: http://www.diastat.com/HTML-INF/Admin_http://www.diastat.com/HTML-INF/Admin_Diastat/Admin_Diastat/How_to_AdministerDiastat/Admin_Diastat/How_to_Administer_Video.htm_Video.htm