The EM Educator Series: Subtleties of Seizures

Authors: Alex Koyfman, MD (@EMHighAK) and Garrett Blumberg, MD (@GarrettBlumberg) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case #1:

A 26-year-old male is brought in by EMS seizing for over 10 minutes. He received midazolam IM X 2 en route, without resolution.

Case #2:

A 2-year-old female with URI and fever presents with parents after a 1 minute generalized “shaking episode” per mom. She appears well now, with a temperature of 38C.



  • What defines a seizure? How are seizures classified?
  • What are etiologies of seizures, adult and pediatric?
  • How do seizures present? Do pediatric and adult seizures present differently?
  • What are seizure mimics?
  • Is there utility in obtaining labs and imaging?
  • What is the ED management for the following:
    1. 1st unprovoked seizure?
    2. 2nd unprovoked seizure?
  • What is the ED management for a known seizure disorder?
  • The seizing patient is not responsive to benzodiazepines… What’s your plan?


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