We have a 1st fit policy agreed with our Neurologists which involves some
baseline blood investigations [including serum Calcium], full neuro
examination, exclusion of precipitating causes [trauma, alcohol etc] - if
all OK and patient fully recovered discharge with neuro OP within 3-4 weeks
[we used to do cranial CT prior to OP but since appt. of new Neurologist
time to OP significantly reduced].
As you should be advising the patient not to drive, operate machinery etc
until given all clear [which often threatens job and compromises lifestyle],
I believe you must have a policy in place which clears [or not] the patient
ASAP so they can get on with their life.
Cheers, Bill
----- Original Message -----
From: "elizabeth gilby" <[log in to unmask]>
To: "Bill Bailey" <[log in to unmask]>
Sent: Wednesday, June 23, 2004 12:52 PM
Subject: Re: First fit
> Has any department developed a "first fit" guideline in adults?
> I am particularly interested in those patients with unprovoked first fits
> who have no ongoing neurological signs or symptoms to warrant medical
> admission.
>
> If so, what investigations are performed in the ED and does anyone have
> experience of investigating these patients via an observation unit? ( ie.
> would you scan all first fitters?)
>
> Our neurology department at present offers no first fit clinic and a
fairly
> long wait for outpatient follow up.
>
> I am trying to develop some guidelines for the management of these
patients
> but there is not much evidence out there!
>
> Many thanks!
>
> Liz Gilby
> ED SpR Bath
>
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