ABSTRACT
This chapter presents a case study of a 35-year-old door-to-door saleswoman who is brought in to the Emergency Department by her husband after he thought she had a 'fit' earlier in the day. The patient's presentation is typical for a generalised tonic-clonic seizure, which is characterised by an abrupt loss of consciousness often accompanied by a loud shriek or shout, followed by a tonic and clonic phase. Most seizures spontaneously resolve within 1-2 minutes and pharmacotherapy is generally not required. Administration of thiamine and dextrose should be considered, particularly if there is a suspicion for alcohol excess or malnutrition. Concurrently, an infusion of fosphenytoin or phenytoin should be established, with alternatives including sodium valproate or levetiracetam if the patient has intolerance to phenytoin. The physical examination should focus on assessing for any localising neurologic signs, and also to evaluate any injuries that the patient may have sustained during the seizure.
