After a patient arrives for treatment, the initial assessment may be incomplete, resulting in inappropriate or inadequte therapy. Not identifying treatable infections, electrolyte imbalance, child abuse, and accidental trauma can lead to rapidly progressive deterioration and demise, or may make seizure control difficult. By not ascertaining anticonvulsant levels in a patient with epilepsy, the physician loses an opportunity to determine whether the anticonvulsant is ineffective or simply at too low a level.
If the emergency physician communicates with the primary physician, unnecessary studies and drugs that either were ineffective or produced some side effects can be avoided. Additionally, it is important to consult with the patient's physician when prescribing nonanticonvulsants that might interfere with anticonvulsants or produce unwanted side effects.
In the aggressive treatment of seizures (SE and recurring breakthrough seizures), inadequate loading doses or improper drug selection may prolong the seizure and worsen the prognosis. Excessive dosage can result in respiratory depression or hypotension and, in rare instances, can exacerbate the seizures. If nonepileptic paroxysmal disorders are not recognized, the patient is put at the additional risk of unnecessary medication and inadequate treatment of the real disorder.
Emergency physicians cannot deal with all the problems facing patients with epilepsy. Follow-up care by the primary physicians or appropriate consultants ensures better compliance and, hopefully, lessens emergency situations in the future.
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