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SEIZURES/FITSManage urgently the patient who is unconscious and fitting:• Ensure the patient is safe. Place in a lateral lying (recovery) position. Do not place anything in the mouth.• Give 40% facemask oxygen.• Check glucose. If < 3.5 or unable to measure, give 50ml of dextrose 50% IV. Continue IV dextrose 5% in sodium chloride 0.9% slowly (30 drops per minute).• If ≥ 20 weeks pregnant up to 1 week postpartum 93 for treatment of fit.• If < 20 weeks pregnant or not pregnant, give diazepam 10mg IV slow infusion over at least 5 minutes or lorazepam 4mg IM/IV stat.• Repeat after 10 minutes if fit continues.• Treat for status epilepticus if:--Fits do not respond to 2 doses of diazepam/lorazepam or--Fits last longer than 30 minutes or--Patient does not recover consciousness between fits.Patient has status epilepticus:• Give phenytoin 20mg/kg IV in sodium chloride 0.9%over 60 minutes. If dysrhythmia develops, stopinfusion.• If fits continue repeat phenytoin 10mg/kg IV insodium chloride 0.9% over 30 minutes.• If IV phenytoin unavailable, give phenytoin 20mg/kgcrushed tablet via nasogastric tube.• Refer urgently to hospital.• Temperature ≥ 38ºC: give ceftriaxone 1 2g IM/IV• Neck stiffness/meningism• HIV patient• Reduced level of consciousness more than 1hour after fit• Glucose still < 3.5 after one hour or patient onglibenclamide or insulinPatient does not have status epilepticus and fit stops:Refer patient same day if:• New weakness, numbness, visual disturbance,facial asymmetry, unable to name 3 out of 3objects (like hand, nose, pen) or recent headaches• BP ≥ 180/110 one hour after fit has stopped• Substance abuse: overdose or withdrawal• Head injury within past 6 weeks• Pregnant or up to 1 week postpartumApproach to patient who is not fitting now and does not need same day referralConfirm that patient indeed had a fit: jerking movements of part of or the whole body, with/without tongue biting, incontinence, post-fit drowsiness and confusion.YesIs patient known with epilepsy?NoEpisode/s of weakness or disturbance of speech for < 24 hours?YesNoPrevious TB meningitis, stroke or head trauma?YesChance of recurrent fit is 50%, even 2years after the event.NoRefer for specialistassessment.YesStroke ortransientischaemicattack likely76.NoEpisodes of acute anxiety?NoCollapse following hot feeling, nausea, prolongedstanding or intense pain with rapid recovery?YesPanic attacklikely 81.Treat for epilepsy 87.Blackout likely 7.Refer for specialist assessment if diagnosis uncertain.1Do not mix Ringer's lactate and IV ceftriaxone. Flush IV line with sodium chloride 0.9% before and after IV ceftriaxone. If giving ceftriaxone IM, divide dose: 1g into 2 different injection sites.TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERS2WOMEN'S HEALTH