Grand Mal attacks. It is a life attacks. It is a life- - PDF document

A seizure is a paroxysmal A seizure is a paroxysmal disorder of cerebral function disorder of cerebral function Medical Emergencies in the Medical Emergencies in the characterized by an attack characterized by an attack Dental Office Dental Office involving changes in the state of involving changes in the state of consciousness, motor activity, or consciousness, motor activity, or y “Seizures” “Seizures” Seizures Seizures sensory phenomena; a seizure is sensory phenomena; a seizure is sudden in onset and usually of sudden in onset and usually of Frank S. Drongowski, D.D.S brief duration. The terms brief duration. The terms Michael E. O’Brien, D.D.S. convulsion and and seizure seizure are are Department of Oral & Maxillofacial Surgery convulsion Louisiana State University School of Dentistry synonymous synonymous New Orleans, Louisiana Status epilepticus is a condition Status epilepticus is a condition Petit Mal Petit Mal in which seizures are so in which seizures are so prolonged or so repeated that prolonged or so repeated that recovery does not occur between recovery does not occur between d d t t b t b t Grand Mal attacks. It is a life attacks. It is a life- -threatening threatening medical emergency medical emergency Petit Mal (Absence attacks) Petit Mal (Absence attacks) Petit Mal (Absence attacks) Petit Mal (Absence attacks) • Children 3-15 years old • Abrupt onset • Attacks last 5-30 seconds • Complete suppression of all mental • Complete suppression of all mental – Petit Mal Status may last for hours or function days • Blank stare • Minor facial clonic movement – blinking Local Anesthesia for Dental Hygienists – Session III Seizure Disorder Michael E. O’Brien, DDS and Frank S. Drongowski, DDS

Generalized tonic- Generalized tonic -clonic seizure clonic seizure Treatment of Petit Mal Treatment of Petit Mal (Grand Mal) (Grand Mal) (Absence attacks) (Absence attacks) • Preictal (prodromal) phase – aura • Discontinue dental treatment • Ictal phase I t l h depending on the duration of the – Seizure activity attack • Postictal phase – Generalized depression of CNS, cardiovascular and respiratory system Treatment of Treatment of Generalized tonic Generalized tonic- -clonic seizure clonic seizure generalized tonic- generalized tonic -clonic seizure clonic seizure (Grand Mal) (Grand Mal) (Grand Mal) (Grand Mal) • Presence of aura prior to loss of • P (position) supine consciousness • Remove all objects from the • Loss of consciousness L f i patient’s mo th if possible patient’s mouth if possible – You need to have patient notify you of • Tonic-clonic muscle contraction an aura • Clenched teeth; tongue biting • 911 • Incontinence – EMT can help assess the need for hospitalization Treatment of Treatment of Status epilepticus Status epilepticus generalized tonic generalized tonic- -clonic seizure clonic seizure (Grand Mal) (Grand Mal) • Treat the same as a Grand Mal seizure • Prevent injury to the patient • Consider Valium 10 mg IV or IM C id V li 10 IV IM • A-B-C if necessary – If true status epilepticus Valium can • Discharge the patient or ER save the patient – Depends on severity of attack • Call 911 – This patient is going to the ER Local Anesthesia for Dental Hygienists – Session III Seizure Disorder Michael E. O’Brien, DDS and Frank S. Drongowski, DDS

There is often tonic There is often tonic- -clonic activity clonic activity when a patient has an episode of when a patient has an episode of syncope which may lead you to syncope which may lead you to QUESTIONS? QUESTIONS? QUESTIONS? QUESTIONS? suspect that the patient is having suspect that the patient is having p p p p g g a seizure. In the absence of a a seizure. In the absence of a history of seizure, you have to history of seizure, you have to decide whether to send the patient decide whether to send the patient for a work for a work- -up. up. Local Anesthesia for Dental Hygienists – Session III Seizure Disorder Michael E. O’Brien, DDS and Frank S. Drongowski, DDS