Emergency Care Textbook Professional Responders - Part 13 PDF

13 Acute and Chronic Illnesses Key Content Altered Mental Status............ Syncope................................ Diabetic Emergencies.............. Seizures.................................... Types of Seizures.................. Epilepsy................................. Peritonitis.................

13 Acute and Chronic Illnesses Key Content Altered Mental Status............ Syncope................................ Diabetic Emergencies.............. Seizures.................................... Types of Seizures.................. Epilepsy................................. Peritonitis................................ Appendicitis............................. Bowel Obstruction.................. Gastroenteritis........................ Kidney Stones......................... Peptic Ulcers............................ Gastrointestinal (GI) Bleeding............................... Urinary Tract Infection (UTI).... 248 248 249 251 251 252 253 253 254 254 255 255 255 256 Introduction Sometimes, there are no warning signs or symptoms to indicate a medical emergency caused by an acute or a chronic illness. Other times, a patient may only be able to communicate that he or she is feeling ill or that something is wrong. Symptoms may also be atypical; for example, older adults or those with diabetes may have a heart attack without experiencing chest pain. Conditions such as diabetes, epilepsy, and high-altitude illness can cause a variety of signs and symptoms, including sudden, unexplained altered mental status. A patient may complain of ACUTE AND CHRONIC ILLNESSES An illness can be categorized as either acute (with a sudden onset) or chronic (persisting over time). Both acute and chronic illnesses can develop into sudden medical emergencies either rapidly or gradually. 247 feeling light-headed, dizzy, or weak. The patient may also feel nauseated or may vomit. Respiration, pulse, and skin characteristics may change. Ultimately, if a patient looks and feels ill without having experienced trauma, this could indicate a medical emergency that requires immediate care. When helping a patient with a general medical complaint, perform the standard assessment and care processes, such as conducting primary and secondary assessments and providing any indicated interventions. ALTERED MENTAL STATUS Altered mental status is often characterized by a sudden or gradual change in a patient’s level of responsiveness, including drowsiness, confusion, and partial or complete loss of responsiveness. Altered mental status is sometimes caused by a temporary reduction of blood flow to the brain, such as when blood collects or pools in the legs and lower body. Syncope ACUTE AND CHRONIC ILLNESSES Syncope (fainting) occurs when the brain is suddenly deprived of its normal blood flow and momentarily shuts down. 248 Syncope may occur when blood flow to the brain is momentarily reduced. It can be triggered or caused by the following: Pain Emotional shock A drop in blood pressure A pinched blood vessel in the neck A drop in blood sugar Certain medications Standing for a long time Exposure to heat Overexertion Medical conditions (e.g., heart disease) Pregnant women and older adults may be more likely than other patients to experience syncope while suddenly changing positions (e.g., moving from lying down to standing up). A patient may faint with or without warning. Often, the patient may first feel light-headed or dizzy. There may be signs of shock, such as cool, moist, pale or ashen skin. The patient may feel nauseated and complain of numbness or tingling in the fingers and toes. The patient’s respiration and pulse may become faster. CARE FOR SYNCOPE Make sure the patient’s airway is open, and place an unresponsive patient in the supine position. Have suction equipment ready for use. Do not allow the patient to eat or drink, as this can increase the chance of vomiting. Since a patient’s condition may deteriorate and make communication impossible, attempt to gain information quickly from the patient, family members, or bystanders. Any information you can obtain may assist with the patient’s treatment, both at the scene and after care is transferred. Sometimes, a patient may briefly faint and slowly begin to regain responsiveness. Syncope often resolves itself when the patient moves from a standing or sitting position to a reclining position. When normal circulation to the brain resumes, the patient usually regains responsiveness within minutes. Syncope itself does not usually harm the patient, but a fall may lead to an injury. Take SMR precautions if necessary. If you can reach a patient who is starting to collapse, gently lower the patient to the ground or another flat surface (without risking injury to yourself). Place the patient in a supine position. Assess the patient’s respiration and pulse, and loosen any restrictive clothing. Although the patient usually recovers quickly, the underlying cause may not be clear. Any altered mental status can be an indicator of a serious underlying condition. Always conduct a thorough assessment of any patient who has experienced a loss of responsiveness. The body’s cells need glucose (sugar) as a source of energy to function normally. Through the digestive process, the body extracts glucose from food, which is then absorbed into the bloodstream. Insulin (a hormone produced in the pancreas) is required for the transfer of glucose from the bloodstream to the body’s cells. Without a proper balance of glucose and insulin, the cells will starve and the body will not function properly. Diabetes mellitus is a condition in which the body either fails to produce enough insulin or does not effectively use the insulin it does produce. There are two major types of diabetes. Type 1 diabetes (insulin-dependent diabetes) occurs when the body does not produce enough insulin for its needs. Most people with insulindependent diabetes have to inject insulin into their bodies daily. This type of diabetes often begins in childhood and so can be referred to as juvenile diabetes. Type 2 diabetes can be insulin-dependent or non-insulin-dependent diabetes. It occurs when the body does not produce enough insulin for its needs, or when the body does not properly use the insulin it produces. A person with diabetes must carefully monitor his or her diet and exercise. People with insulindependent diabetes must also regulate their use of insulin (Figure 13–1). When a person with diabetes fails to control these factors, it leads to an excessive or insufficient glucose level, causing an imbalance in the body. The level of glucose may become too high (hyperglycemia) or too low (hypoglycemia). Either imbalance causes illness, which can become a diabetic emergency. Hyperglycemia Hyperglycemia is a condition in which a patient’s blood glucose level (BGL) is too high. In patients with diabetes, this usually occurs when the insulin level in the body is too low: Because this prevents glucose from transferring to the body’s cells, it results in a buildup of glucose in the blood. The body’s cells do not receive sufficient glucose from the bloodstream even though it is abundant. The body attempts to meet its need for energy by using other stored food and energy sources (e.g., fats). Converting fat into energy produces waste products and increases the acidity level in the blood, causing a condition called acidosis. As this occurs, the patient becomes ill. If it continues, the hyperglycemic condition deteriorates into a diabetic coma. A patient with diabetes may use an insulin pump, which is a small portable device consisting of an external pump and a small tube that fits under the patient’s skin. This device provides continuous doses of insulin throughout the day and can be adjusted to meet the patient’s insulin requirements. If you encounter an insulin pump during your patient assessment, this may be a clue that the patient’s condition could be a diabetic emergency. Some pregnant women develop diabetes as an effect of pregnancy: This is referred to as gestational diabetes. Healthy diet and exercise can help to reduce the risk, but medication may be necessary as well. Gestational diabetes usually disappears after a woman gives birth, but ongoing monitoring may be necessary. Figure 13–1: People with insulin-dependent diabetes must regulate their use of insulin. They may need to check their blood glucose level frequently. ACUTE AND CHRONIC ILLNESSES DIABETIC EMERGENCIES 249 Hypoglycemia Hypoglycemia occurs when the BGL in the blood is too low. In patients with diabetes, this often occurs when the insulin level in the body is too high (but it may have other causes as well). A patient’s BGL can become too low if a patient with diabetes: Takes too much insulin. Fails to eat adequately. Over-exercises and uses glucose more quickly than it is replaced. In this situation, the small amount of glucose in the blood is used up rapidly, and there is not enough for the brain to function properly. This can result in an acute condition called insulin reaction, which can be life-threatening. Many people with diabetes carry a glucometer, a device with which they can test their blood glucose level (BGL). Signs and Symptoms of Diabetic Emergencies The signs and symptoms of hyperglycemia and hypoglycemia are somewhat different, but common signs and symptoms include: Changes in the level of responsiveness, including dizziness, drowsiness, and confusion. Tachypnea (rapid breathing). Tachycardia (rapid pulse). Feeling and looking ill. ACUTE AND CHRONIC ILLNESSES It is not important for you to differentiate between hyperglycemia and hypoglycemia: The standard treatment for both conditions is the same. Giving glucose to a hyperglycemic patient will not cause additional harm. 250 Treatment for Diabetic Emergencies If the patient is known to have diabetes (as identified in your secondary assessment) and exhibits the signs and symptoms previously stated, you should suspect a diabetic emergency. Figure 13–2: If a patient having a diabetic emergency can safely swallow and follow directions, have him or her chew 2 to 5 glucose tablets or provide oral glucose gel. Test the patient’s blood glucose level (BGL). If possible, find out what the patient’s average reading is. A normal BGL is usually between 4 and 7 mmol/L. After assessing the reading, determine whether you will use oral glucose. Local protocols often govern the treatment of diabetic emergencies, but the following guidelines may be followed. If the patient is able to follow directions and swallow safely, he or she should chew 2 to 5 glucose tablets (Figure 13–2). Other oral glucose products are available (e.g., glucose gel): Follow the manufacturer’s recommendation for their use. If signs and symptoms persist 5 to 10 minutes after the first dose of glucose, the patient should be placed in the rapid transport category. Provide a second dose of glucose. Supplemental oxygen is also indicated. When transferring care, ensure that you communicate about any glucose the patient has received. Never give any patient insulin. Glucose gel is a concentrated form of glucose designed for rapid absorption. If glucose gel is included in your local protocol and scope of practice, it may be used for an unresponsive patient with suspected hypoglycemia. To administer glucose gel: 1. Ensure that the patient is in the semiprone position. 2. Ensure that suction devices are ready to use. 3. Remove any airway adjuncts that could interfere with the administration of oral glucose. 4. Place approximately 12 grams (half a tube) of gel on the inside of the patient’s lower cheek. You may use a tongue depressor for this step. The more thoroughly you spread the glucose on the patient’s cheek, the more quickly it will be absorbed. GLUCAGON Glucagon is a substance that can be injected (intramuscularly or subcutaneously) into a hypoglycemic patient to increase his or her BGL by accelerating the breakdown of glycogen into glucose. It should be used when the patient has signs and symptoms of hypoglycemia and is unable to protect his or her airway (i.e., when oral glucose is not indicated). Glucagon should only be given to an adult with a BGL lower than 4 mmol/L or a child with a BGL lower than 3 mmol/L. Glucagon is a fast-acting medication with a short half-life: It will be largely metabolized within 30 minutes. A patient who receives glucagon should also ingest additional sugar and/or complex carbohydrates. Glucagon also stimulates the release of catecholamines. In the presence of pheochromocytoma, glucagon can cause the tumor to release catecholamines, which may result in a dangerous sudden and marked increase in blood pressure. Because glucagon is derived from animal products, it is contraindicated if a patient has a hypersensitivity to pork or beef proteins. SEIZURES A seizure is the result of abnormal electrical activity in the brain. It can cause temporary changes in movement, function, sensation, awareness, or behaviour. Seizures can occur when the normal functions of the brain are disrupted by injury, disease, fever, infection, metabolic disturbances, or conditions causing a decreased oxygen level. Types of Seizures GENERALIZED SEIZURES Generalized tonic-clonic seizures, also called grand mal seizures, are the most well-known type of seizure. They involve both hemispheres of the brain and usually result in loss of responsiveness. This type of seizure rarely lasts for more than a few minutes. Before a generalized seizure occurs, the patient may experience an unusual sensation or feeling called an aura. An aura in this context can include a strange sound, taste, or smell, or an urgent need to get to safety. If the patient recognizes the aura, he or she may have time to sit or lie down and warn bystanders before the seizure occurs. Generalized seizures usually last 1 to 3 minutes and can produce a wide range of signs and symptoms. When a seizure occurs, the patient loses responsiveness and can fall, causing injury. The patient may become rigid and then experience sudden, uncontrollable muscular contractions that can last several minutes. Breathing may become irregular and even stop temporarily. The patient may drool, and the eyes may roll upward. As the seizure subsides and the muscles relax, the patient may lose bladder or bowel control. The four stages of generalized seizures are: 1. Aura phase: The patient may sense something unusual (not all patients will experience an aura). 2. Tonic phase: The patient appears unresponsive and experiences muscle rigidity. 3. Clonic phase: The patient experiences uncontrollable muscular contractions (convulsions). 4. Postictal phase: The patient displays diminished responsiveness with gradual recovery and confusion (he or she may feel confused and want to sleep). ACUTE AND CHRONIC ILLNESSES GLUCOSE GEL 251 PARTIAL SEIZURES FEBRILE SEIZURES Partial seizures can be simple or complex, and they are the most common type of seizure experienced by patients with epilepsy. They usually involve a small area of one hemisphere of the brain. A partial seizure can spread and become a generalized seizure. In simple partial seizures, the patient usually remains aware of his or her surroundings. Complex partial seizures usually last for 1 to 2 minutes, though they may last longer, and awareness is either impaired or lost while the patient remains responsive. Young children and infants may be at risk of febrile seizures, which are seizures brought on by a rapid increase in body temperature. They are most common in children under the age of 5 years. In simple partial seizures, there may be involuntary muscular contractions in one area of the body (e.g., the arm, leg, or face). Some patients cannot speak or move during a simple partial seizure, although they may remember everything that occurred. Simple partial seizures may produce a feeling of fear. They can also produce odd sensations such as strange smells or hearing voices. In rare occurrences, strong emotions such as anger or joy can be brought on by a seizure. Complex partial seizures often begin with a blank stare followed by random facial movements (e.g., smacking the lips or chewing). The patient may appear dazed or be clumsy. The patient’s activities may be lacking in direction, and he or she may be unable to follow directions or answer questions. This type of seizure usually lasts for a few minutes but may last longer. The patient generally cannot remember what happened and may be very confused. Provide reassurance and calmly explain what happened. ACUTE AND CHRONIC ILLNESSES ABSENCE (PETIT MAL) SEIZURES 252 Individuals may also experience an absence seizure, also known as a petit mal seizure. These are most common in children. During an absence seizure, there is brief, sudden loss of awareness that may be mistaken for daydreaming. There may be little to no movement, and the patient may appear to have a blank stare (though eye fluttering and chewing movements may also appear). This type of seizure is also referred to as a non-convulsive seizure, since the body remains relatively still during the episode. Most often, these seizures last for only a few seconds. Febrile seizures are often caused by ear, throat, or digestive system infections and are most likely to occur when a child or an infant runs a rectal temperature of over 39°C (102°F). A patient experiencing a febrile seizure may experience some or all of the following signs and symptoms: Sudden rise in body temperature Change in level of responsiveness Rhythmic jerking of the head and limbs Loss of bladder or bowel control Confusion Drowsiness Rigidity Holding the breath Rolling the eyes upward STATUS EPILEPTICUS Status epilepticus is a seizure that lasts longer than 5 minutes or a series of repeated seizures lasting longer than 5 minutes without a return to normal responsiveness between them. If you suspect that a patient is experiencing this type of seizure, the patient is in the rapid transport category, as this a serious medical emergency and can be fatal. If the seizure passes, place the patient on his or her side and suction the patient’s airway. Epilepsy Epilepsy is a term used to describe a group of neurological disorders in which the individual experiences recurrent seizures as the main symptom. Most epileptic seizures last only a few seconds. People living with epilepsy can often control seizures with medication, and sometimes epilepsy can resolve with age. In more severe cases, the frequency of seizures may be reduced through curative surgical re-sectioning or implanted devices (e.g., a vagus-nerve stimulator). While some patients require lifelong medical therapy, sometimes medication may be reduced or even eliminated over time. When treating a patient who is having a seizure, there are two main priorities: preventing injury and managing the airway. To protect the patient from injury, move nearby objects (e.g., furniture, wires, and electronic devices) away from the patient. Do not place anything in the patient’s mouth to prevent the patient from biting his or her tongue or cheek. It is rare that an actively seizing patient bites hard enough to cause significant bleeding, and this intended precaution may act as an airway obstruction instead. Manage the patient’s airway by positioning the patient on his or her side, if possible; doing so will allow fluids (saliva, blood, vomit) to drain away from the mouth. Never put your fingers into the mouth of an actively seizing patient to clear the airway. In some cases, the patient may be in the postictal phase by the time you arrive. Check to see if the patient was injured during the seizure. Offer comfort and reassurance, especially if the seizure occurred in public, as the patient may feel embarrassed or self-conscious. Keep bystanders well back to provide maximum privacy, and stay with the patient until he or she is fully responsive. Transport Decision for Seizures The patient will usually recover from a seizure in a few minutes. If you discover the patient has a history of seizures that are medically controlled, you may not need to escalate the patient to the rapid transport category. However, the following cases indicate the patient is in the rapid transport category: It is the patient’s first seizure. You are uncertain about the cause of the seizure. The patient presents with status epilepticus. The seizure takes place in water. The seizure is the result of trauma. The patient is pregnant. The patient is known to have diabetes. The patient is a child or an infant. The patient fails to regain responsiveness after the seizure. The patient is an older adult who may have suffered a stroke. MIGRAINES A migraine is more than just a bad headache: It is a debilitating condition that can include a severe headache, visual disturbances, confusion, and other neurological effects. Migraines usually subside within 4 hours but may persist for up to 3 days. If a migraine occurs, pain-relieving medication can reduce the symptoms. A patient who experiences chronic migraines should consult a physician for assessment, especially if there is an increase in the frequency or intensity of attacks. Preventive medications may be prescribed for patients with chronic migraines. PERITONITIS Peritonitis is an inflammation of the peritoneum (abdominal cavity lining) that presents with acute abdominal pain and tenderness. Coughing, flexing the hips, and releasing manual pressure from the abdomen all tend to elicit more pain. A common cause of peritonitis is blunt trauma to the abdominal or pelvic region, as internal damage can cause fluid or infectious material to enter the peritoneum from other parts of the body. Treatment includes IV therapy, as well as possible antibiotics or surgery. Patients with peritonitis should be placed in the rapid transport category. APPENDICITIS Appendicitis is an acute inflammation of the appendix. Appendicitis occurs as a result of a viral or bacterial infection in the digestive tract, or when the channel in the appendix becomes blocked. If it is untreated, the appendix may become gangrenous and rupture, causing inflammation of the membrane that covers the peritoneum. ACUTE AND CHRONIC ILLNESSES Care for Seizures 253 The signs and symptoms of appendicitis include: Abdominal pain or cramping. Nausea or vomiting. Constipation. Diarrhea. Low-grade fever. Abdominal swelling. The pain usually begins near the umbilical area and diffuses, later becoming intense and localized in the lower right quadrant. The pain becomes worse for the patient when he or she moves, takes deep breaths, coughs, sneezes, or is touched in the abdomen. The definitive care for appendicitis is surgical removal of the appendix. While caring for a patient with appendicitis, place the patient in a comfortable position and transport him or her for emergency surgery immediately. BOWEL OBSTRUCTION ACUTE AND CHRONIC ILLNESSES A bowel obstruction occurs when the intestinal tract becomes occluded, preventing the normal flow of intestinal contents. This condition may be caused by a number of factors, including adhesions, hernias, fecal blockage, and tumours. Bowel obstruction in the small intestine is usually caused by adhesions or hernias. Bowel obstruction in the large intestine is usually caused by tumours or fecal obstruction. The signs and symptoms of a bowel obstruction include: Abdominal pain. Constipation. Abdominal distension. 254 An obstructed bowel may result in perforation with generalized inflammation of the peritoneum, resulting in infection. Any patient with a bowel obstruction should be placed in the rapid transit category. The patient should not eat or drink anything. Treatment includes fluid replacement and antibiotics. Sometimes, surgery is necessary to correct the obstruction. GASTROENTERITIS Gastroenteritis refers to inflammation of the GI tract, often as a result of a viral infection. This may be caused by poor hygiene, improper food preparation, or improper water disinfection. Signs and symptoms of gastroenteritis generally have a rapid onset and short duration. They may include: Nausea and vomiting. Diarrhea. Headache (due to dehydration). Abdominal cramps. Fever. Gastroenteritis may resolve without treatment, but a patient should be assessed by a physician if any of the following signs or symptoms appear: Dehydration Blood in the vomit or stool Inability to keep liquids down for more than 24 hours Vomiting for more than 2 days (or several hours for infants) Fever of 40°C (104°F) for adults or 39°C (102°F) for infants and children Lethargy and irritability (especially in children and infants) Other conditions may have similar signs and symptoms to gastroenteritis, but they are typically much more serious. A patient with any of the following signs and symptoms is not suffering from gastroenteritis: Localized, constant pain Slow pain onset Rebound tenderness Abdominal rigidity Signs of internal bleeding or shock If these signs and symptoms are evident, the patient should be placed in the rapid transport category. Find out what the patient last ingested and if anyone else is experiencing similar symptoms; this could provide clues as to the cause. Kidney stones are solid concentrations of dissolved minerals found in the kidneys or ureters that usually pass during urination. However, if kidney stones cause a blockage that obstructs the flow of urine, the patient can present with the following signs or symptoms: Pain in the side, lower abdomen, or groin (usually radiating from the back to the front) Nausea or vomiting Restlessness Possible blood in the urine Kidney stones cause severe pain, commonly referred to as renal colic. Depending on the level of pain or severity of the signs and symptoms, the patient may wait for the stones to pass, or he or she may be in the rapid transport category. PEPTIC ULCERS A peptic ulcer is a small erosion inside the GI tract. Peptic ulcers can be caused by gastric destruction or by hydrochloric acid in the intestinal mucosal lining. Helicobacter pylori infection and ulcers treated with some prescribed medications may also play a role in causing peptic ulcers. Other major causes of peptic ulcers include the chronic use of medications (e.g., ASA) and cigarette smoking. The major symptom of a peptic ulcer is a burning or gnawing feeling in the stomach area that can last anywhere from 30 minutes to 3 hours. This pain is often misinterpreted as heartburn, indigestion, or hunger, and it usually occurs in the upper abdomen or below the sternum. In some individuals, the pain occurs immediately after eating; in others, it may not occur until hours after eating. Some symptoms include loss of appetite and weight loss. The pain frequently awakens the patient at night, and he or she may experience weeks of pain, followed by weeks without any pain. Pain can be relieved by drinking milk, eating, resting, or taking antacids. Peptic ulcers can also occur in the duodenum (the first part of the intestine). Other symptoms include recurrent vomiting, blood in the stool, and anemia. Prescription medication is needed to treat peptic ulcers and/or relieve their symptoms. As such, the patient should be assessed and treated by a physician. If the patient is in extreme pain or has concerning symptoms (e.g., respiratory distress), he or she may be placed in the rapid transport category. GASTROINTESTINAL (GI) BLEEDING There are multiple causes of GI bleeding. The causes vary based on the location of the bleeding within the gastrointestinal tract. Bleeding in the upper GI tract originates in the esophagus, stomach, or duodenum. This condition may be caused by peptic ulcers, gastritis, stomach cancer, or the ingestion of caustic poisons. Bleeding in the lower GI tract originates in the small intestine, large intestine, rectum, or anus. This condition may be caused by diverticular disease, polyps, hemorrhoids, anal fissures, cancer, or inflammatory bowel disease. A patient with GI bleeding may experience vomiting of blood, bloody bowel movements, or black, tarry stools. Symptoms that may accompany GI bleeding include fatigue, weakness, abdominal pain, pale skin, and shortness of breath. Serious GI bleeding can have a significant impact on vital signs; for instance, it can cause blood pressure to drop sharply and pulse to increase. The patient is in the rapid transport category, as he or she may require a blood transfusion or surgery. ACUTE AND CHRONIC ILLNESSES KIDNEY STONES 255 URINARY TRACT INFECTION (UTI) ACUTE AND CHRONIC ILLNESSES A urinary tract infection (UTI) is usually a bacterial infection found within the urinary tract. It can affect the urethra, bladder, or kidney, as well as the prostate gland in males. These infections are very common. The signs and symptoms of a UTI include: An urgent need to urinate often. Burning during urination. Cloudy or foul-smelling urine. Pain in the lower abdomen. 256 Females are at a greater risk of urinary tract infection because of their shorter urethra. Other groups that are at higher risk for UTIs include paraplegics and people with nerve disruption to the bladder (e.g., people with diabetes). People with urinary stasis (incomplete emptying of the bladder, which may provide nutrition to pathogens) are also predisposed to the infection. This latter group includes pregnant women and people with neurological impairment. Prescription medication is often needed to treat a UTI or relieve UTI symptoms. SUMMARY ALTERED MENTAL STATUS: SYNCOPE Cause A temporary reduction of blood flow to the brain General Treatment 1. 2. 3. 4.  nsure patient is in the supine position. E Do not allow the patient to eat or drink. Have suction equipment ready. Conduct patient assessment. DIABETES Type 1 Diabetes Insulin-dependent: The body does not produce  nough insulin for its needs. e Type 2 Diabetes Insulin-dependent or non-insulin-dependent: The body does not produce enough insulin for its needs, or it does not properly use the insulin it produces. Hyperglycemia Blood glucose level (BGL) is too high; usually occurs when the body’s insulin level is too low. Hypoglycemia BGL is too low; usually occurs when the body’s insulin level is too high. General Signs Changes in LOR; tachypnea; tachycardia; feeling and Symptoms and looking ill. General Treatment 1. T  est the patient’s BGL and determine an  average reading if possible. 2. If patient can follow directions and swallow  safely, administer 2 to 5 glucose tablets or  other oral glucose products. 3. If signs and symptoms persist 5 to 10 minutes  after first dose of glucose, put patient in the rapid transport category and provide a second dose of glucose and supplemental oxygen. When to Transport  a Seizing Patient It is the patient’s first  seizure. You are uncertain about  the cause of the seizure. The patient presents with  status epilepticus. The seizure takes place in  water. The seizure is the result  of trauma. The patient is pregnant. The patient is known to  have diabetes. The patient is a child or  an infant. The patient fails to regain  responsiveness after the  seizure. The patient is an older  adult who may have  suffered a stroke. Generalized Other names: generalized tonic-clonic; grand mal Has four stages: 1. Aura phase: senses something unusual; not all patients will have this 2. Tonic phase: appears unresponsive and experiences muscle rigidity 3. Clonic phase: experiences convulsions 4. Postictal phase: shows reduced responsiveness with gradual recovery and confusion Simple Partial Seizures Aware of surroundings; convulsions on one part of body; may not speak or move but can remember the event; feelings of fear and odd sensations Complete Partial Seizures Blank stare followed by random facial movements; may seem lost or confused; difficulty following directions or answering questions; no memory of event Absence Other names: petit mal; non-convulsive seizure Most common in children Patient may experience: brief, sudden loss of awareness; little to no convulsions Patient may have: blank stare, very subtle, random facial movements Febrile Most common in children under 5 years old Usually occur if child has a rectal temperature over 39°C (102°F) Status Epilepticus Lasts longer than 5 minutes or occurs repeatedly for more than 5 minutes Patient in rapid transport category ACUTE AND CHRONIC ILLNESSES TYPES OF SEIZURES 257 SUMMARY 258