Manual: Looking After A Child With Epilepsy

Transcription

1 Manual: Looking After A Child With Epilepsy Table of Contents 1. What is epilepsy? Causes of epilepsy Triggers Signs and symptoms Types of seizures Focal seizures Generalised seizures What to do if the child you are caring for has a seizure Basic important steps to remember for all seizures: Wheelchair first aid during a seizure Wheelchair first aid following a seizure When to call an ambulance Emergency medications Common Seizure Medications Midazolam Diazepam Clonazepam How to administer emergency medication Buccal medication Intranasal medication Rectal medication Points to remember when giving a medication rectally What to do after giving emergency medication for a seizure References Version 2.0 Date revised October, 2012 Next revision date October, 2014 Page 1 of 14

2 1. What is epilepsy? Epilepsy is a disorder of the brain that results in recurrent seizures often called epileptic fits or convulsions. The seizures happen because there is an uncontrollable electrical discharge/activity from the nerve cells in the brain. A seizure occurs when the brains nerve cells misfire and generate sudden, uncontrolled burst of electrical activity in the brain. The orderly communication between nerve cells becomes scrambled and our thoughts, feelings or movements become momentarily confused or uncontrolled A seizure may create a temporary disturbance in the way the brain works and cause uncontrolled sensations, feelings, abnormal movement or behaviour. Seizures can vary greatly in their duration and intensity anywhere from a few seconds to multiple minutes, depending on the type of epileptic seizure and the child s past history. Epilepsy affects each individual differently. Children with epilepsy can usually lead a normal and active life with some precautions on certain activities when managed with or without interventions. It is important you know what to do specifically for the child in your care and how to help the child if they have a seizure. 2. Causes of epilepsy In most children with epilepsy, no cause can be found. In some children epilepsy can be linked to the following; Structural abnormalities of the brain Infections of the brain A lack of oxygen to the brain A brain injury resulting in scar tissue of the brain Epilepsy sometimes runs in families and other family members will have epilepsy 3. Triggers Sometimes certain things or triggers can make seizures more likely to occur for children with epilepsy. Triggers may include: Infections and Illness Change in sleep pattern or decreased sleep Stress Temperature change Photosensitivity Menstruation Change in medications or missed medications Diet It is important to remember that children with epilepsy may or not have triggers which result in a seizure, and that triggers vary for each individual. It is important you know what to do specifically for the child in your care and how to avoid or manage triggers. 4. Signs and symptoms Signs and symptoms of seizures vary for each child. The common ones include: Sensory disturbances tingling, numbness, changes to what they see, hear or smell or unusual feelings that may be hard to describe Abnormal body movements child may be limp, stiff or jerking, have shallow or jerky breathing Page 2 of 14

3 Abnormal behaviour child may be confused or have automatic movements such as picking at clothing, chewing and swallowing or appearing afraid Loss of consciousness: not responsive to you Combination of any of the above 5. Types of seizures There are many different types of seizures and they can be generally classified into two groups called focal seizures or generalised seizures. The difference between the two types of seizures is where they begin in the brain. 5.1 Focal seizures This is when the seizure activity begins in only one part of the brain, known as the focal point in the brain. Partial or focal seizures usually affect the part of the body which is controlled by that area of the brain. This type of seizure may affect only one part or side of the body. The child may or may not lose consciousness. 5.2 Generalised seizures Generalised seizures occur when the seizure activity begins all over the brain and therefore affects the whole body. The child s level of conscious is always affected. Specific types of generalised seizures include: Tonic-clonic seizures, convulsive seizures Absence seizures, or starring seizures Myoclonic, atonic and tonic seizures 6. What to do if the child you are caring for has a seizure 6.1 Basic important steps to remember for all seizures: Move dangerous objects away from the child and make the child as safe as possible Time the seizure Perform DRSABC (see Basic Life Support manual section)if required When the seizure is finished, place the child in the recover position and monitor their airway and breathing. Do Not Speak calmly and reassuringly during seizure Try to stop the seizure Put anything in the child s mouth Try to restrain the child, as this usually causes injury to the child or the carer 6.2 Wheelchair first aid during a seizure If they are in a chair, leave them there if they are safe Make sure the brakes are on and the wheelchair is secure Protect the child by supporting their head. Place something soft under or on the sides of the head if there is no moulded headrest to reduce injury to their head. Check whether you need to move any hard objects that might hurt the child Ensure the child s airway is clear. Suction if available, to clear the airway Page 3 of 14

4 Perform DRSABC (see Basic Life Support manual section). Remove the child from their chair if they are not breathing to administer breaths. 6.3 Wheelchair first aid following a seizure When the seizure has stopped, make sure the child s airway is clear. Remove any remaining food or vomit from their mouth and support their head to maintain a clear airway as needed. Ensure the child s airway is clear. Suction if available, to clear the airway If safe to do so, remove the child from the wheelchair at the end of the seizure and place in the recovery position Monitor airway and breathing 7. When to call an ambulance You don t have to call an ambulance every time a seizure happens to a child who has epilepsy. Please refer to the child specific care pages regarding the individual epilepsy care plan. You should call an ambulance if: You think it is the child s first seizure or you do not know The seizure lasts more than the time allowed in the child specific plan The child remains unconscious or has trouble breathing after the seizure The seizure happens in water The child is hurt or injured They have diabetes As detailed in the child specific care page Page 4 of 14

5 8. Emergency medications The child you are caring for may need regular medication to manage and prevent seizures from happening. In some cases, the child may need to be given emergency medication, in the event of a seizure lasting for an extended time or if the seizure is not resolving. These include medication inside the cheek (buccal) up the bottom (rectal), in the nose (intranasal). If the child you are caring for requires emergency medication you are responsible for ensuring that their medication is always close by and accessible during your shift. Reasons for administering emergency medications include: If the child is having a seizure lasting longer than a certain amount of time If the child is having a pattern of seizures that occur close together (called a cluster) 9. Common Seizure Medications There are a number of different medications that can be used to stop a seizure. Please refer to the child specific plan for which medicine to give, when to give it, how much to give, how to give it and when to call an ambulance. 9.1 Midazolam Midazolam is a medication usually given buccally or intranasally. Midazolam is a sedative and works to relax the child s abnormal brain activity. Midazolam is the most commonly prescribed buccal medication. It needs to be stored at room temperature (below 25 o C), protected from light (in a box or wrapped in foil), and keep out of the reach of children. The plastic ampoules are labelled "for slow or IV or IM injection" but can be administered buccally. The most common side effects of midazolam are: It has a sedative effect and the child may become sleepy for some time afterwards (which is also common after a seizure) Headache Nausea (feeling sick) Vomiting In rare cases, the child may become agitated, hostile or aggressive The child may have shallow or slow breathing after having midazolam. If this happens, perform DRSABC (see Basic Life Support section) 9.2 Diazepam Diazepam (Valium) is a medication that helps to relax muscles, slow brain activity to help stop seizures. Diazepam is the most commonly prescribed rectal medication for children with epilepsy. It is stored at room temperature and can be given orally and is sometimes given rectal. The most common side effects of diazepam are: Tiredness Drowsiness Dizziness Loss of memory The child may have shallow or slow breathing after having midazolam. If this happens, perform DRSABC (see Basic Life Support section) Page 5 of 14

6 You must insert the tube into the rectum to make sure the medication is absorbed properly If the diazepam is given too fast it causes the rectum to tighten which means the medication is more likely to be pushed out 9.3 Clonazepam Clonzepam (Rivotril) iss a medication which relaxes the muscles and helps stop a seizure. Clonazepam is commonly given orally and can be stored at room temperature. The most common side effects of clonazepam are: Drowsiness Dizziness Loss of memory Inattentiveness Confusion Headache, hangover feeling in the morning Slurred speech Unpleasant dreams Increased saliva In rare cases the child may have shallow or slow breathing after having midazolam. If this happens, perform DRSABC (see Basic Life Support section) How to administer Clonazepam: Procedure 1. Wash your hands (can use ABHR) 2. Count out the amount of drops prescribed onto a soft (silicone or plastic) spoon. Do not give the medication directly from the bottle to patient as you can easily give too much. 3. Lay the child in the recovery position. 4. Using a 2nd spoon open their lips and trickle the clonazepam from the spoon into the inside of the cheek lowest to the ground, between the lips and side teeth. The solution does not need to be swallowed 5. Watch the child's breathing and seizure activity while they remain lying on their side in the recovery position 6. Wash your hands (can use ABHR) Page 6 of 14

7 10. How to administer emergency medication 10.1 Buccal medication Buccal (inside the cheek) medication may be prescribed for a child with epilepsy who is experiencing a seizure. Procedure 1. Call for an ambulance 000 unless otherwise advised by the child specific care page. Open the plastic ampoule of medication by twisting off the top. 2. Insert the syringe into the ampoule and hold the ampoule and syringe upright with the ampoule higher. Withdraw the amount of medication needed into the syringe. Push out any big air bubbles and check the amount of medication in the syringe. Pull the ampoule and the syringe apart. Page 7 of 14

8 3. Lay the child on their side in the recovery position. Open their lips and trickle the medication from the syringe into the inside of the cheek lowest to the ground, between the lips and side teeth. There is no need to open the child's jaw. The solution does not need to be swallowed. 4. Monitor the child's breathing and seizure activity while they remain lying on their side in the recovery position. 5. Write down the time that the seizure started, when medication was given, when the seizure stopped and any other details you feel are important. 6. Wait for the ambulance to arrive. 7. Contact the child s parents and explain the situation 10.2 Intranasal medication Intranasal medication is given in the nose this helps it to be absorbed directly into the blood stream. Midazolam is the most commonly prescribed intranasal medication for a child with epilepsy who: Procedure 1. Call for an ambulance 000 unless otherwise advised. Open the medication plastic ampoule by twisting off the top. Page 8 of 14

9 2. Insert the syringe into the ampoule and hold the ampoule and syringe upright with the ampoule higher. Withdraw the amount of medication needed into the syringe. Push out any big air bubbles and check the amount of medication in the syringe. Pull the ampoule and the syringe apart. 3. Position the child so that their face is up and their head is tilted back slightly. This may mean rolling the child onto their back or side, away from the normal recovery position. 4. Drip 2-3 drops of the prescribed dose of medication into one nostril then 2-3 drops into the other nostril, alternating sides until all the prescribed medication is given. If using an atomizer use the same method spraying a small amount into each nostril, alternating sides until all the prescribed medication is given. 5. Put the child on their side into the recovery position, monitor their breathing and seizure activity. 6. Write down the time that the seizure started, when medication was given, when the seizure stopped and any other details you feel are important. 7. Wait for the ambulance to arrive. 8. Contact the child s parents and explain the situation Page 9 of 14

10 10.3 Rectal medication Rectal medication is given in the bottom and may be prescribed for children with epilepsy. The RCH rectal diazepam kit contains: Procedure A 25 ml bottle of diazepam (1 mg/ml) A reusable 10 ml syringe A reusable soft plastic tube to attach to the syringe for drawing up and injecting the diazepam Lubricating jelly Disposable gloves 1. Call for an ambulance 000 unless otherwise advised. 2. Open the RCH rectal diazepam kit and remove contents from the box and attach the tube to syringe. Put on disposable gloves. 3. Draw up prescribed dose of medication and get rid of any air in the syringe. Page 10 of 14

11 4. Lubricate the tip of the insertion tube with lubricating gel. Recheck the dose in the syringe is the same as the prescribed dose, ensuring no air bubbles. 5. Place the child in the recovery position and bend the child s upper leg forward. 6. Separate the child s buttocks to expose the anus (back passage). Page 11 of 14

12 7. Gently insert the tube into the anus until it is half way in and inject the medication slowly over about 20 seconds. 8. Withdraw syringe and tube slowly count to three, while holding buttocks together to prevent leakage. 9. Keep the child on their side in the recovery position, watching their breathing and seizure activity. Page 12 of 14

13 10. Write down the time that the seizure started, when medication was given, when the seizure stopped and any other details you feel are important. 11. Wait for the ambulance to arrive. 12. Contact the child s parents and explain the situation Points to remember when giving a medication rectally If the rectum is full of faeces (poo) and the tube is put into the faeces, it will affect absorption of the diazepam. If it is hard to put the tube in, withdraw it and try again at a slightly different angle to avoid the faeces The tube is made of a soft plastic and it is almost impossible to tear the bowel with it 11. What to do after giving emergency medication for a seizure Procedure 1. Stay with the child 2. Continue to monitor the child, check for a clear airway by following the steps in the basic life support section of the manual 3. If the child is breathing, leave them in the recovery position and monitor the breathing (Look, listen and feel) 4. Write down the time you gave the emergency medication 5. If they are having difficulty breathing: Watch for any further seizure activity Reposition the child, to make sure their airway, is open Suction the child if able Rouse child by touching and talking to them If you have called an ambulance: When the ambulance arrives, tell them: The time the seizure started If the child is a known epileptic or if it is their first known seizure The type of medication given The time of medicine given The dose of medicine given If the medicine had any effect Page 13 of 14

14 12. References Kid s Health Information, Royal Children s Hospital, Melbourne, Australia. Rectal Diazepam, Instructions for Home Use, Children s Epilepsy Program, Department of Neurology & Pharmacy Department, Royal Children s Hospital, Melbourne, Australia. Children s Epilepsy Program, Royal Children s Hospital, Melbourne, Australia. Epilepsy Action (Victoria) Epilepsy Australia MIMS On-Line, Epilepsy Action Australia Page 14 of 14