Disposition

There are no evidence-based rules for how long a patient must be observed prior to discharge. Some clinicians discharge patients with nontherapeutic anticonvulsant levels after administration of a loading dose of an anticonvulsant, if vital signs are normal and the mental status is at baseline. As previously discussed, therapeutic serum concentrations can be achieved as early as one hour after IV-loading of phenytoin. Patients given oral loading doses should be warned of continued risk for seizures until anticonvulsant effect has been achieved. If possible, the patient should be discharged with a reliable family member or friend, with imperative medical follow-up arranged in a week.

Patients should be instructed to take precautions to minimize the risks for injury from further seizures. Swimming should be avoided. Working with hazardous tools or machines and working at heights should be avoided. The emergency physician should be familiar with driving regulations and reporting requirements, which vary from state to state. Regardless of local laws, it is prudent to advise patients against driving and other hazardous activity until they have stabilized and have been seen in follow-up. The emergency department record should reflect the precise instructions given to the patient.

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