Question

You are called to a residential facility well known to you for residents with complex medical issues that require dependent care. On arrival to the group home you are greeted by the staff who report one of the residents has had a generalized tonic-clonic seizure lasting 2-3 minutes. There are no immediate threats to you or your crew. As you enter the facility you see an approximately 25 year old man lying on the floor. He is positioned on his side and does not appear to be moving. There is no obvious evidence of trauma. There are no other patients nearby.

As you kneel next to the patient you notice he is obviously breathing but remains unconscious. There is no blood, vomit or secretions in his airway. He is breathing shallow without accessory muscle use and has a pulse that is present and at an adequate rate. Your partner places the patient on oxygen using a nasal cannula at 2 liters per minute flow. His skin is warm, pink and dry, there is no obvious external bleeding. You partner begins a head-to-toe assessment while you talk with the staff about his history.

The resident was sitting in a chair practicing work related skills putting a nut onto a bolt when he appeared distracted to the vocational therapist, who witnessed the seizure. The staff report that about 30 minutes ago the patient began exhibiting aural signs of an impending seizure. They describe his behavior as impatient and mildly aggressive, both typical for the patient before a seizure. They activated his vagal nerve implant but the patient did not cough as typical when the vagal nerve stimulator was activated. They attempted activation again 2-3 times but no cough resulted. The patient then began to seize. He was assisted to the floor without trauma and after the seizure ended they placed him on his side while waiting for EMS.

The staff report the patient has a history of absence seizures and complex partial seizures. They have never seen this patient have a generalized tonic-clonic seizure and it is not reported in his medical history. The patient is obese, and suffers cognitive deficits related to learning deficits since birth. He is 23 years old but is at the functional level of a 10-12 year old. He is able to perform simple activities of daily living with minimal assistance and usually cooperates with instructions. The patient takes the following medications: gabapentin, topiramate, clonazepam and an experimental anti-epileptic drug (AED), rufinamide. They report he has an allergy to penicillin. His vital signs are as follows, pulse, 98, strong and regular, the cardiac monitor shows a sinus arrhythmia, respirations are 16 and shallow, skin is pink, warm and dry, capillary refill is 2 seconds, blood pressure is 146/78 in a lying position, oxygen saturations are 94% on 2 liters per nasal cannula.

1) what other assessment, or diagnostic information you will assess on this patient?

2) What are potential complications this patient that will get related to the medications he is taking?

3) What are the causes for his seizure today?

Answer 1

1. Electroencephalography is an ideal diagnostic test for a patient with seiure,the presence of interical epileptiform dischargw on EEG helps a diagnosis of Epileptic Seiures.

2. Potential complications of

Gabapentin are- Teratogenicity,hypoventillation,respiratory failure and myopathy.

Topiramate- Tiredness,drawsiness,dizziness,nervousness,numbness or tingly feeling in the hands and feet,coordination problems,diarrhoea,weight loss,speech/language problems,vision impairmnet,sensory distortion,anorexia,bad taste in mouth,confusion,slowed thinking,trouble concentrating or paying attention,stuffy nose,sneeing,sore throat, Kidney stone,, mood swings,tachypnoea.

Clonazepam- confusion,amnesia,lack of coordination,dizziness,drawsiness,slurred speech,insomna,blurred vision,irregular heartbeat,decreased sex drive,slowed breathing,hypotension,nausea and vomiting,inability to urinate,tremors,depression,Extreme fatigue,aggression and agitation,Delucious,hallucination.

AED- drawsiness,irritability,nausea,rash,clumsiness, emotional,memory or behavioral disturbance,Occationally this drug will increase the number of seizures a person is having.

Rufinamide- headache,dizziness and tiredness.

3. As the patient had past history of seizures, there is a chance of recurrence.

As the patient has the mental disability there is a chance of seiure activity due to the abnormal brain function.

there is a chance of seizure activity as a result of complication of his routine drugs.