Seizure Management Plan

Transcription

1 Seizure Management Plan PERSONAL INFORMATION Name: Birth Date: Address: 1 st Emergency Contact: Relationship: 2 nd Emergency Contact: Relationship: SEIZURE INFORMATION Seizure Type What Happens How Long it Lasts How often TRIGGERS & MANAGEMENT (how to avoid) Trigger 1: Trigger 2: Trigger 3: SMP-ED-V1July2012 Epilepsy Action Australia 2012 Page 1 of 4

2 WARNING SIGNS (of impending seizure) Seizure Management Plan Warning 1: Warning 2: Warning 3: RECOVERY Recovery Description: DAILY SEIZURE MEDICINE Medicine Name How much is taken How often is it taken How is it taken (dosage amount) SMP-ED-V1July2012 Epilepsy Action Australia 2012 Page 2 of 4

3 Seizure Management Plan OTHER SEIZURE TREATMENTS Device Type: Model: Serial Number: Date Implanted: Dietary Therapy: Special instructions: Other Therapy: Special instructions: SEIZURE FIRST AID Tonic Clonic Seizures (convulsive seizure where the body stiffens followed by general muscle jerking) Stay with the person Time the seizure Protect from injury especially the head Roll onto side after jerking stops or immediately if food/fluid/vomit in mouth Observe & monitor breathing Gently reassure until recovered DO NOT Put anything in the person s mouth Restrain the person Move unless in danger Focal Dyscognitive Seizures (non-convulsive seizure with outward signs of confusion, inappropriate responses or behaviour) Stay with the person Time the seizure Gently guide away from harm Reassure until recovered DO NOT Restrain the person unless in danger ATTACH FIRST AID FOR SEIZURES POSTER SMP-ED-V1July2012 Epilepsy Action Australia 2012 Page 3 of 4

4 WHEN SEIZURES REQUIRE ADDITIONAL HELP Seizure Management Plan Type of Emergency: Description: CALL AN AMBULANCE (000) IF... You are in any doubt about what to do Injury has occurred There is food/fluid/vomit in the persons mouth The seizure occurs in water The person has breathing difficulties after the seizure stops Another seizure quickly follows The seizure lasts longer than 5 minutes The person is non-responsive for more than 5 minutes after the seizure ends HEALTH CARE CONTACTS Epilepsy Specialist Name: Epilepsy Nurse Name: Preferred Hospital Name: General Practitioner Name: SIGNATURES Review this plan with your treating doctor to ensure it reflects your current treatment and required responses. This plan will need updating if there are any changes to seizures or management. Doctor Name: Signature: Date: My Signature: SMP-ED-V1July2012 Epilepsy Action Australia 2012 Page 4 of 4

5 Helpful Tips Seizure management plans are called many different names however they essentially contain the same information with the aim to provide anyone, who may be present when you experience a seizure, with enough information to enable them to recognise your seizures and know how to best assist you and keep you safe. Your Personal Information: Your Emergency Contacts: Record the name of the person this plan is about. Record the emergency contact person s name and the best telephone numbers to use during the day and/or evening as well as an address if available. Please note the nominated emergency contact person s relationship to you or your child. Seizure Information: It is important to record a clear description of each seizure type, what occurs at the beginning, middle and end of the seizure so others will recognise the seizure when it happens. If unsure about your or your child s seizure types or what occurs during a seizure, ask any family or friends who have witnessed your seizures to help you out with this section or take this form to discuss with your treating doctor. Triggers and Management: Record any identified triggers or situations that make you or your child more vulnerable to experiencing a seizure. The line below allows you to include any strategy you may have to avoid exposure to identified individual trigger or what to do if you have already been exposed. Warning Signs: Warning signs differ from person to person, some people never experience an aura or warning of an impending seizure. If you or your child experience any warning or aura before a seizure write a detailed description in this section and what can be done in this situation. Daily Seizure Medication: It is important that you check this information is correct and update it when your medications have been changed or the dosage has been altered. This is not a medication order and medications can not be administered using this form unless each medication line has been signed and dated by the prescribing doctor. SMP-ED-V1May2012 Epilepsy Action Australia 2012 Helpful Tips V1 May 2012

6 Helpful Tips continued... Other Seizure Treatments: It is important to record what other treatments you are using to control you epilepsy and what needs to be done in the event of a seizure. For example if you have a Vagal Nerve Stimulator implanted, record the model and serial number as well as the date it was implanted or replaced; if on a dietary therapy record what type of diet and when it was begun. Write down any other therapies you may be using to control your seizures or if you have had epilepsy surgery, the type and when this occurred. Seizure First Aid: Basic Seizure First Aid has been inserted into this section. Attach a copy of the Epilepsy Action Australia Seizure First Aid Poster to this plan. If there are any additional first aid measures required for your or your child s seizures please write this information in the When Seizures Require Additional Help section. When Seizures Require Additional Help: This section is designed for you to record the type of emergency situation (eg clusters or prolonged seizures), a description of what happens so any person assisting you will recognise the emergency and care instructions so they know what to do in each situation. Call An Ambulance: A range of situations are list when it is important that an ambulance is called or medical assistance sought. If there are other situations when an ambulance is required, record this information in the When Seizures Require Additional Help section. Health Care Contacts: Record the name and contact details of the medical or health care provider you want contacted if you or your child is transferred to an emergency department or medical centre after experiencing a seizure. If there are sections of the plan you are unable to complete, take a copy of your plan to your next medical visit or contact your epilepsy nurse to discuss your questions. Once the plan is complete, ask your treating doctor to review it and sign the plan. The plan is then ready for use. Don t forget that epilepsy nurses are available to assist you with completing your plan or to create plans for people with more complex forms of epilepsy or those who require an emergency medication to be administered. FOR HELP CONTACT: EPILEPSY ACTION AUSTRALIA epilepsy@epilepsy.org.au SMP-ED-V1May2012 Epilepsy Action Australia 2012 Helpful Tips V1 May 2012