Special Operations Forces Medical Handbook

4-35

of the affected limb.

Alternate: For recurrent seizures:

1. If the seizure lasts more than 10 minutes, immediate medical intervention is indicated.


2. Begin an IV access line.


3. EEG monitoring if available.


4. Give 5 to 10 mg IV Valium.


5. If this does not stop the seizure, consider Dilantin 1000 mg IV as an infusion over 30 minutes, not to exceed
   50 mg/min. When giving Dilantin as an infusion, do not mix it with D5W because it will precipitate. Clear
   the IV tubing with normal saline rst.


6. If this does not stop the seizure, consider Phenobarbital 10 mg/kg IV over 10 minutes. May be repeated
   one time. Must have a secure airway and closely monitor breathing.


7. If this does not stop the seizure, general anesthesia or barbiturate coma may be required. Advanced care
   will be required.


8. Transport to the nearest MTF for further evaluation and disposition. Use Dilantin 300 mg po or IV qd for
   MEDEVAC transport.
   Always monitor the airway as these drugs may cause respiratory suppression. If IV unavailable, Phenobarbital
   may be given IM. Do not give Dilantin or Valium IM.
   NOTES: If seizure lasts more than ten minutes, there is the possibility of Status Epilepticus. These seizures
   must be stopped ASAP. This is a life-threatening event and may produce signicant brain injury if the patient
   survives. Emergency medical assistance and intervention must be rapidly sought

Patient Education

General: NO DRIVING OR OTHER DANGEROUS ACTIVITIES UNTIL MEDICALLY CLEARED. DMV

reporting per state requirements.

Activity: Normal as tolerated. Avoid sports/activities such as scuba diving, skiing, horseback riding, or activities

where there could be injury to self or others should a seizure occur. Weight lifting with a spotter only.

Diet: Avoid alcohol.

Prevention and Hygiene: Low stress, good diet, exercise, and good sleep hygiene (8 hours per night,

regularly).

Follow-up Actions

Return evaluation: In 2 to 4 weeks as necessary.

Evacuation/Consultation Criteria: Urgent evacuation is not normally required. Patients should ultimately be

referred for a non-emergent, ROUTINE Neurological Consultation.

NOTE: Though epilepsy aficts up to 1% of the population, non-epileptic convulsive events are considerably

more common.

Neurologic: Meningitis

CDR Robert Wall, MC, USN & COL Naomi Aronson, MC, USA

Introduction: Meningitis is an acute, life-threatening infection of the lining of the brain and spinal cord. It
can be caused by a virus, bacteria, fungus, parasite, or more complex organism. Travel to exotic places,
especially those with questionable sewage and pest control, increases the risk of acquiring and disseminating
this disease. Bacterial meningitis is rapidly progressive and should be considered an emergency. Aseptic
meningitis (normally caused by viruses) has a slower course. Meningitis is a treatable and potentially curable
disease if diagnosed and treated early. However, delays in diagnosis and treatment can lead to permanent
neurological disability and possibly death.

Subjective: Symptoms
Fever, stiff neck, headache, photophobia, malaise; later: delirium, coma, seizures, nausea, vomiting, dizziness
Focused History: How fast did your symptoms progress? (period of hours for bacterial meningitis, but longer