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

Seizure Disorder Michael E. O’Brien, DDS and Frank S. Drongowski, DDS Local Anesthesia for Dental Hygienists – Session III

Medical Emergencies in the Medical Emergencies in the Dental Office Dental Office “Seizures” “Seizures” Seizures Seizures

Frank S. Drongowski, D.D.S Michael E. O’Brien, D.D.S. Department of Oral & Maxillofacial Surgery Louisiana State University School of Dentistry New Orleans, Louisiana

A seizure is a paroxysmal A seizure is a paroxysmal disorder of cerebral function disorder of cerebral function characterized by an attack characterized by an attack involving changes in the state of involving changes in the state of consciousness, motor activity, or consciousness, motor activity, or y sensory phenomena; a seizure is sensory phenomena; a seizure is sudden in onset and usually of sudden in onset and usually of brief duration. brief duration. The terms The terms convulsion convulsion and and seizure seizure are are synonymous synonymous

Petit Mal Petit Mal

Grand Mal

Status epilepticus is a condition Status epilepticus is a condition in which seizures are so in which seizures are so prolonged or so repeated that prolonged or so repeated that d t b t d t b t recovery does not occur between recovery does not occur between

• attacks. It is a life
• attacks. It is a life-
• threatening

threatening medical emergency medical emergency Petit Mal (Absence attacks) Petit Mal (Absence attacks)

• Children 3-15 years old
• Abrupt onset
• Complete suppression of all mental
• Complete suppression of all mental

function

• Blank stare
• Minor facial clonic movement

– blinking

Petit Mal (Absence attacks) Petit Mal (Absence attacks)

• Attacks last 5-30 seconds

– Petit Mal Status may last for hours or days

Seizure Disorder Michael E. O’Brien, DDS and Frank S. Drongowski, DDS Local Anesthesia for Dental Hygienists – Session III

Treatment of Petit Mal Treatment of Petit Mal (Absence attacks) (Absence attacks)

• Discontinue dental treatment

depending on the duration of the attack

Generalized tonic Generalized tonic-

• clonic seizure

clonic seizure (Grand Mal) (Grand Mal)

• Preictal (prodromal) phase

– aura

I t l h

• Ictal phase

– Seizure activity

• Postictal phase

– Generalized depression of CNS, cardiovascular and respiratory system

Generalized tonic Generalized tonic-

• clonic seizure

clonic seizure (Grand Mal) (Grand Mal)

• Presence of aura prior to loss of

consciousness L f i

• Loss of consciousness
• Tonic-clonic muscle contraction
• Clenched teeth; tongue biting
• Incontinence

Treatment of Treatment of generalized tonic generalized tonic-

• clonic seizure

clonic seizure (Grand Mal) (Grand Mal)

• P (position) supine
• Remove all objects from the

patient’s mo th if possible patient’s mouth if possible

– You need to have patient notify you of an aura

• 911

– EMT can help assess the need for hospitalization

Treatment of Treatment of generalized tonic generalized tonic-

• clonic seizure

clonic seizure (Grand Mal) (Grand Mal)

• Prevent injury to the patient
• A-B-C if necessary
• Discharge the patient or ER

– Depends on severity of attack

Status epilepticus Status epilepticus

• Treat the same as a Grand Mal

seizure C id V li 10 IV IM

• Consider Valium 10 mg IV or IM

– If true status epilepticus Valium can save the patient

• Call 911

– This patient is going to the ER

Seizure Disorder Michael E. O’Brien, DDS and Frank S. Drongowski, DDS Local Anesthesia for Dental Hygienists – Session III

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 suspect that the patient is having suspect that the patient is having p p g p p 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.

QUESTIONS? QUESTIONS? QUESTIONS? QUESTIONS?