Case Study: Neurological Emergency

The 21 year old female is Epileptic. She developed tonic/clonic seizures lasting approximately 2 minutes after they began. The patient does not have history of any injury. She is wearing a bracelet labelled PMHx, which is a medic alert stating that she is epileptic. There is no known medication that she is taking.

Her perfusion cap refill is <2s, pale. Her pupils appear equal and reactive. The GCS is 10 (2-3-5) with her body temperature being 36.4 oC. The ECG is normal sinus Tachycardia and Oedema is Nil. Further examination reveal that the patient does not tolerate OPA and has a gag reflex. The patient has reported incontinent of urine. 2, In the pool side, the patient is lays on the ground in a recovery position, but has not regained her full recovery. She appears uninjured. On examination, her vital signs include a pulse rate of 120 and is regular, respiration sound is nil adventitious sounds, her blood pressure is 122/65, blood glucose is 4.0 mmol, Sa0

Provisional Diagnosis:

The provisional diagnosis include Syncope, Metabolic conditions such as hypoglycaemia, hypernatremia, migraine, vascular conditions, sleep disorders, movement disorder and psychiatric conditions. Based on the examination data available, the differential diagnosis include cardio embolic stroke, the first adult seizure, frontal lobe epilepsy, idiopathic orthostatic hypotension and possible transient global amnesia. There are also possibility of migraine headache.

: Assessment

. ., 2012)et alThim A: Airway is assessed if the patient has difficulties talking. If the patient is not able to talk, her face is put sideways to enhance airway patent by looking at obstructions, chest movement and cyanosis. The examination process should feel for breath through the neck. This examination also require checking for breath sounds with stridor and wheeze sounds, (

. ., 2012)et alThim B: Breathing- The examination assess evidence for respiratory distress, accessory muscle usage, and cyanosis, nasal flaring, pursed lips and gasping. The examination should also look for thorax wounds and evidence of sweating. Tracheal deviation should be accessed, (

. ., 2012)et alThim C: Circulation- the examination should look for visible blood loss, anaemia, cyanosis, sweating and jugular vein pressure, as the peripheral perfusion is felt, capillary refill, pulse rate and oedema are checked (

.., 2012)et alThim D: Disability- should look for alert or response to voice or pain and unresponsiveness, the GCS is applied if response is impaired and blood-glucose-level is checked (

. ., 2012)et alThim E: Exposure- exposure examination should evaluates for the signs of haemorrhage, infection, and any injury. An examination for gross neurological deficit is also foreseeable. Examination should also check for pupillary response and papilledema (

: Pathophysiology

. Hirose, 2013)The pathophysiology of epilepsy is the paroxysmal occurrence of the disturbances of the function of the brain. The direct involvement of epileptic process is a characteristic behaviour that occurs in depolarizing neurones in response to brain disturbance. The spread of epileptic activity results from inhibition mechanism of involved neural membrane. Neural mechanism and response to brain disturbances are associated with epileptic events that delay in terminating seizures hence the differential diagnosis of epilepsy of seizure (

: Investigations

. The events that occurred for the patient require definitive diagnosis that will be for treatment. , 2012)et al.Douw Further investigation that needs to be carried out for this patient include making a correct diagnosis that would identify epileptic condition and seizure. The medical history of the patient will be considered during further investigation to determine whether the type of treatment the patient is taking (

: Treatment

. Since the history of medication for the patient will be factored in the treatment the past treatment drugs will be evaluated for its effectiveness before determining whether the patient need a change in medication. ., 2008)et alPaschal Seizures are controlled by the anticonvulsant drugs. There are a line of drugs that treat seizures, but the main purpose of these drugs is to control the epileptic seizures as compared to treating the seizures (

: Transport

At the scene examination is not sufficient to determine the condition of the patient. The patient has a history of epilepsy. The patient will be taken to her primary care physician as compared to taking the patient to an emergency room of the nearby outpatient facility. Epileptic patients require less time to recover, but the decision to take this patient to the hospital is made for the purpose of further investigation so that she can be given appropriate care and treatment. Health insurance is also a factor to consider when arranging for transportation and determining the hospital the patient should be taken. If the patient has health insurance cover, it will be appropriate to call for the hospital ambulance.


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, 117-21.5 ,Int J Gen Med Thim, T., Krarup, N. H., Grove, E. L., Rohde, C. V., & Løfgren, B. (2012). Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach.

(5), 509-520.65 ,Brain and nerve= Shinkei kenkyu no shinpo Hirose, G. (2013). An overview of epilepsy: its history, classification, pathophysiology and management.

(7), 1115-1122.49 ,Epilepsia Paschal, A. M., Hawley, S. R., Romain, T. S., & Ablah, E. (2008). Measures of adherence to epilepsy treatment: review of present practices and recommendations for future directions.