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12)   Nervous System Disorder You witness a man drop to the floor unconscious in a shopping centre....

12)   Nervous System Disorder
You witness a man drop to the floor unconscious in a shopping centre. On examination he is stiff, having jerky spasmodic body movements, has bitten his tongue and passed urine

12.1)   What is the most probable diagnosis

12.2)   What is Status epilepticus?

12.3)   How you would manage the patient?

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Answer #1

12.1) Probable diagnosis for an unconscious person with symptoms of stiffness,jerky spasmodic movements ,tongue bite and urine passage is GRAND-MAL SEIZURE also called TONIC CLONIC SEIZURE which is a type of generalised seizures.

SEIZURES are classified into two types-GENERALISED SEIZURES

FOCAL SEIZURES

GENERALISED SEIZURES-1)TONIC CLONIC OR GRAND-MAL SEIZURES

2)ABSENCE OR PETIT MAL SEIZURES

   3)MYOCLONIC SEIZURES

4)CLONIC SEIZURES

5)TONIC SEIZURES

6)AKINETIC OR ATONIC SEIZURES

FOCAL SEIZURES--1)SIMPLE FOCAL SEIZURES

2)COMPLEX FOCAL SEIZURES

3)SECONDARILY GENERALISED SEIZURES

12.2)STATUS EPILEPTICUS

Status epilepticus ia a single epileptic seizure lasting for more than 5 min or two or more seizures with in a five minute period without the person returning to normal between them.

It is a life threatening medical emergency if treatment is delayed

in children main cause is an infection with fever and in adults the cause is stroke,change medication,direct trauma to brain,previous history of seizures etc

In general terms it is a dangerous condition in which epileptic fits follow one another without recovery of consciousness

12.3)MANAGEMENT OF GRANDMAL SEIZURE

-OBSERVE THE SITUATION FIRST

-CLEAR THE CROWD.ALLOW SOME VENTILATION

-CLEAR ANY SHARP OBJECTS OR OBSTACLES OR DANGEROUS SUBSTANCES FROM THE PERSON

-DONT TRY TO HOLD THE PERSON OR DONT TRY TO STOP THE MOVEMENTS(JERKS)

-PROTECT THE HEAD-IF AVAILABLE USE A PILLOWOR CUSHION

-PLACE THE PERSON IN SIDE LYING POSITION,SO THAT AIRWAY IS CLEARED

-MONITOR THE SEIZURE-OBSERVE THE TIME IN YOUR WATCH-TIME OF ONSET OF SEIZURE,DURATION,TIME OF NEXT SEIZURE,GAP BETWEEN TWO SEIZURE EPISODES ETC

-DONOT PUT ANYTHING IN HIS OR HER MOUTH

-STAY CALM

-DONOT PANIC THE PERSON

-DONOT MOVE THE PERSON ESPECIALLY DURING SEIZURE EPISODE

-TALK TO THE PERSON TO MAKE SURE HE HAS REGAINED HIS CONSCIOUSNESS

-CONTACT EMERGENCY SERVICES AND GIVE EXACT LOCATION

-DONOT GIVE FOOD OR WATER BECAUSE OF RISK OF ASPIRATION

-DONOT RESTRAIN,REMOVE ANY TIGHT THING OR CLOTHES AROUND NECK

-STAY WITH THE PERSON TILL SEIZURE IS STOPPED AND HE IS SHIFTED TO AMBULANCE

-WHILE SHIFTING THE PERSON MAKE SURE HIS HEAD IS WELL SUPPORTED AND AIRWAY SHOULD BE CLEAR.

CONCLUSION:

FIRST AID FOR A PERSON WITH SEIZURES SHOULD ALWAYS AIM AT KEEPING THE PERSON SAFE UNTILL HE RECEIVES A MEDICAL CARE.SO BE PATIENT AND FOLLOW THE PROTOCOLS

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