Neurological Emergency Essay Example

Neurological Emergency Case Study

The patient is a 21 year old lady who presents signs of an epileptic seizure that happened after completing a training session. A tonic seizure lasting about 2 minutes had been observed and the patient is yet to regain consciousness, but is uninjured. The patient is epileptic as she is wearing a medic alert bracelet stating her condition.

Provisional Diagnosis

The provisional diagnosis indicates tachypnoea and a history of epileptic seizures causing the patient’s loss of consciousness. The increased breathing rate will reduce the rate of oxygen supplied to the cells and thus, a prompt medical attention is paramount.

Assessment

1. Airway: The patient is at resting position and the airway is blocked since she cannot tolerate an OPA; this means she has a gag reflex.

2. Breathing: The respiration is abnormal at 30 showing a difficulty in breathing; oxygen saturation in the blood is at normal ranges with SaO₂ at 93%, the breath sounds are normal with indications for no abnormal signs.

3. Circulation: The pulse is above normal at 120, but regular. This can be attributed to the training session where an individual engaging in exercise will have a pulse above 100 and may take some time before normalising. The blood pressure is normal at 122/65; perfusion shows pale indication at Cap refill of less than 2s, as well as the patient has been incontinent of urine. An ECG check indicates a normal sinus tachycardia.

4. Disability: The patient’s level of consciousness indicates normal pupils as they are equal and reactive (sluggish) and the blood glucose is normal at 4mmol.

5. Exposure: The temperature is normal at 34.6^oC, no injuries present after observation and no oedema.

Pathophysiology

Epilepsy is a brain disorder that is characterised by generation of epileptic seizures. Statistics indicate that at one in thirty people in the UK develop epilepsy at some stage in their lives. In the US, epilepsy affects over 3 million people and is termed as the most common neurological disorder in the world (Stephen & Brodie, 2011). The highest prevalence of the condition is experienced with children and people aged above 60 years. Head trauma, a stroke history and epilepsy are risk factors that are connected to the occurrence of epilepsy (Stafstrom, 2014).

Seizures are caused by paroxysmal discharges from groups of neurons arising from excessive excitation or inhibition loss (Barker-Haliski& White, 2015). The abnormal electrical activity that causes epilepsy arises from biochemical processes at the cellular level exciting the neurons and hyper synchronisation. The chemical imbalance occurs suddenly at the neuronal membranes giving rise to abnormal electrical discharges that may be observed through an ECG test (Wong, Adams & Jackson, 2008).

Epileptic seizures may arise from head injury and critical observation of the head is necessary for a patient experiencing seizures after an active session of exercise. Seizures may also give rise to various physiologic changes with systemic responses probably arising from the surge of catecholamine (Stafstrom, 2014). The patient is presenting normal blood pressure and blood sugars meaning she has not had extensive muscle activity to cause complications in the two features.

Investigation

The need for further analysis of the patient is necessary to ensure accurate understanding of the condition. Conducting an ECG (12-lead ECG) will help to ascertain the risks of epilepsy and reduce rate of mortality. An ECG is a critical diagnosis for epilepsy to indicate the source seizures and is conducted regularly. Changes in heart rate can clarify the timing of seizure onset and the given patterns are critical in the diagnosis. An abnormality observed in the ECG frequently in a patient indicates epileptic attack (Wong, Adams & Jackson, 2008).

Treatment

First, the patient requires management of breathing to normalise the breathing rate and prevent hyperventilation from occurring. Further, epileptic medication should be administered in line with the patient’s age and prevailing condition. Majority of epileptic seizures are managed well with medication especially the anti-convulsant drugs like tegretol which helps in managing secondary tonic/clonic seizures. Seizures are effectively controlled by treatment in about 4 of every 5 cases (Stephen & Brodie, 2011). However, the treatment prescribed to a given patient is dependent upon the severity of the condition, age, medical history and overall health of the patient. Management of the patient to contain urine will be achieved upon management of the epileptic seizures.

Transport

The patient requires immediate neurological attention due to the high rate of ventilation and obstructed airway. An ambulance should be stand-by as the patient is observed for any improvement and immediate transportation to neurological healthcare facility ought to take place as soon as possible.

References

Barker-Haliski, M. & White, H.S. (2015). Glutamatergic mechanisms associated with seizures and epilepsy. Cold Spring Harb Perspect Med., 5, a0222863.

Stafstrom, C.E. (2014). “Recognising seizures and epilepsy; Insights from Pathophysiology.” In J.W., Miller & H.P. Goodkin (Eds.). Epilepsy. Hoboken: Wiley Blackwell.

Stephen, L.J. & Brodie, M.J. (2011). Pharmacotherapy of epilepsy: Newly approved and developmental agents. CNS Drugs, 25, 89.

Wong, S.H., Adams, P. & Jackson, M. (2008). The electrocardiograph (ECG) in a first seizure clinic. European Journal of Epilepsy, 17(8), 707-710.