seizures have been with us since the beginning of recorded history today we
know the science behind seizures the search continues for a cure but
effective first line therapies are already proven
this video provides an overview of seizure types and treatment options
essential information for you
the EMS responder
yeah
more than 50 million people worldwide live with epilepsy
every year millions more suffer seizures from other causes the brain consumes
twenty percent of the bodies oxygen and thirty percent of cardiac output
problems can occur when glucose blood flow oxygen or electrical activity
deviate from the norm seizures are caused by abnormal electrical discharges
in the brain and are classified as either generalized or partial those that
are generalized such as tonic clonic are the result of abnormal electrical
activity affecting the entire brain these seizures are obvious to the
observer a rapid loss of consciousness falling to the ground
full body convulsions generalized tonic-clonic seizures often result in
calls for EMS response
partial seizures however are more difficult to recognize
in partial seizures only part of the brain is affected by the abnormal
electrical activity symptoms presented depend on which area of the brain is
affected
simple partial seizures cause changes in sensation or motor activity in part of
the body but do not result in a loss of awareness on the other hand complex
partial seizures do result in a loss of awareness though the person stays
conscious
they may exhibit a blank stare repetitive motions or an emotional
disturbance complex partial seizures can be difficult to recognize and can easily
be confused with drug or alcohol abuse those who experienced recurrent
unprovoked seizures are diagnosed with epilepsy
there are certain things that may trigger seizures in people with epilepsy
such as flashing lights hunger stress and sleep deprivation for people without
epilepsy the list of possible seizure causes is long and it's not always
possible to determine the cause while on the scene but it is possible to prevent
secondary injuries from environmental factors and with medication and oxygen
help prevent possible neurological damage from prolonged seizures while
most seizures do not cause permanent neurological damage prolong seizures can
be life-threatening
time is requesting an ambulance from station 1 and an officer to respond to
main 1100 Main street for female having a seizure
you respond to a report of a person on the ground and convulsions
the first thing upon arriving is to size up the scene
make sure the area is safe look around for science and environmental factors
that could have caused such as and electrical wires or chemical spill
then check the patient's level of consciousness and response using AVPU (Alert, Verbal, Painful, Unconscious)
look for evidence of trauma drug or alcohol use talk to witnesses
when did the seizure start what was the person doing just prior their
information could provide vital clues
make sure to look for a medical ID bracelet watch or pendant many people
with epilepsy or diabetes where an ID with an emergency phone number and a
clear labeling of their condition
check the person's belongings for prescription medications that may give a
clue regarding a potential illness also a growing number of people have an ice
listing in case of emergency contact in their cell phone directory
I at this point you should be able to assess whether this is an urgent
situation requiring rapid medical intervention or one where you can take a
more conservative approach
now let's look at two common forms of seizures generalized tonic-clonic and
complex partial and the postictal post seizure state
generalized tonic-clonic is the most dramatic of seizures affecting both
hemispheres of the brain the result severe muscle spasms loss of
consciousness muscle rigidity the convulsive period of a tonic clonic
seizure rarely lasts longer than three to four minutes in the vast majority of
cases the seizure itself poses no life-threatening risk
however the environment can present a threat clear the area to prevent injury
during convulsions
if possible place the person on their side in the recovery position to allow
secretions to drain and suction as necessary
don't try to restrain their movement but protect their head and extremities as
they convulse don't put anything in their mouth
in fact check to make sure a bystander hasn't inserted an object thinking it
was the right thing to do
your first priorities even while the patient is still seizing check their
level of consciousness there LOC provide and maintain a clear airway assess
respiratory status and provide oxygen if necessary
next as soon as seizing stops assess pulse rate assess blood sugar and treat
if necessary
perform a head-to-toe evaluation for other injuries when providing a clear
airway
keep in mind that the preferred device is the nasopharyngeal airway the NPA if
necessary
suction for secretions until the patient is alert enough to maintain their own
airway next assess the respiratory status during a seizure
the victim may become a apneic or develop peripheral cyanosis due to
respiratory muscles being paralyzed
this should be a temporary state resolves itself as the tonic spasm
portion of seizure subsides usually in 10 to 30 seconds
all seizure patients should be placed on high-flow oxygen via a non-rebreather
mask monitor the patient closely and be ready to provide positive pressure
ventilation if necessary
monitor LOC for changes next check their pulse rate seizures sometimes occur just
prior to cardiac arrest
so continue to monitor closely most seasons are self-limiting and subside
within three to four minutes or less
but seizures that lasts longer than five minutes can cause more serious
neurological and other organ damage
in fact if you can confirm that seizure activity has lasted longer than five
minutes or that the patient has had repeated seizures without regaining
consciousness in between they may be having a prolonged seizure or even
status epilepticus a true life threatened state with extremely high
mortality rates
the goal is to stop the seizure as soon as possible
these patients need immediate aggressive treatment oxygenation and medication if
authorized obtained vascular access and consider the following medications to
reduce or eliminate the seizure activity
benzodiazepines are the most common class of drugs given to rapidly stop an
active seizure
several are available each with its own benefits
Diazepam known by the brand Valium is a common choice
Lorazepam known as Ativan as the advantage of duration of effectiveness a
few hours versus 30 to 40 minutes for Diazepam Midazolam am also known as versed
has the advantage of being able to be given IV or IM Diastat available by
prescription is administered directly for patients over two years of age and
seizure emergencies caregivers family members and school staff are often
trained to administer this medication in the pre-hospital setting following
physician orders
as all benzodiazepines can cause respiratory depression verify with
caregivers of the patients about medications that may have been
administered prior to your arrival
be prepared to support ventilation remember only medicate if the seizure
has lasted longer than five minutes
another situation where medication can help is one hypoglycemia is causing a
seizure
wait until the seizures over and then check blood sugar levels
dextrose is indicated if the patient has low blood glucose if low treat for local
protocols in summary give oxygen administer a benzodiazepine if the
patient is seizing longer than five minutes or has repetitive seizures check
their blood glucose levels and treat for local protocols another decision facing
EMS is whether to transport the tonic clonic seizure patient to the hospital
follow your local protocols on this but also consider the following transport is
always recommended for patients having a first time seizure
in addition transport is also recommended under any of the following
conditions the seizure last longer than five minutes
a second seizure begin shortly after the first concludes consciousness does not
return after the seizure is over the person is injured pregnant or diabetic
or the seizure happened in water
you think you have epilepsy
however transport may not be necessary if the person has previously been
diagnosed with epilepsy as a history of seizures is fully awake and oriented and
requests not to be transported
now let's move on to another common form of seizure complex partial I can't even
get words out of my mouth half the time when i'm having the seizures I mean
don't know where my mind is at I don't know where I'm at
I don't know where my body is at a complex partial seizure can occur when
abnormal electrical activity happens in the area of the brain controlling
consciousness because only a small part of the brain is affected
a person may be able to perform activity that uses gross motor skills like
walking yet be totally unaware of their actions
they may also exhibit behavioral abnormalities that mimic psychiatric
problems or drug abuse
the patient may stare mumble repeat phrases blink excessively smack their
lips pick up their clothing or disrobe
they will be totally unresponsive to instructions and appear to be in an
altered state of consciousness because they are in fact experiencing a seizure
he doesn't seem to be responding to my question the key to distinguishing
complex partial seizures from psychiatric problems or drug use is the
sudden onset of symptoms and the non directed nature of their actions
I just
his awareness of anything it's almost like being unconscious
i'm told that my eyes world rapidly link
no medication is indicated for the patient suffering a complex partial
seizure
instead assistant these ways to avoid physical contact
touching the patient could cause an involuntary but violent response
approach slowly from the rear or side speak calmly and advise the person of
your actions
stay with the patient until he or she regains consciousness at the conclusion
of all seizures
the patient may enter a postictal state which can last 10 to 60 minutes or
longer
I'm with the ambulance are you okay looks like you had a seizure during this time it is normal
for them to be confused and tired eventually he or she will slowly regain
consciousness and become aware that they've had a seizure
they should be given no pills food or liquids until fully awake
this is a good time to conduct a more thorough exam and collect witness
accounts from bystanders
you can use the sample mnemonic signs and symptoms
note the duration of the various phases of the seizure the postictal state any
injuries and caused the seizure if it's apparent
allergies a severe allergic reaction may trigger a seizure
so ask about allergies to medication medications and anti-seizure medications
one of the most common causes of seizures in a person with epilepsy is
abrupt withdrawal from anti-seizure medication which can happen by simply
missing a daily dose changes in formulations can lead to break through
seizures and seizures can also happen as a result of an overdose of
non-prescription drugs past medical history
does the person have a history of brain injury epilepsy hypoglycemia or diabetes
for example last oral intake events leading up to the incident ask the
patient what happened just prior to the seizure get this information from
bystanders as well
lastly determine whether transport to a hospital is required defer to local
protocols when making this decision but be aware that many complex partial
seizure patients may refuse transport if they have a history of seizures and are
familiar with the experience in general there's no need to transport the complex
partial seizure patient to a hospital
if the person is diagnosed with epilepsy they are alert and oriented within 15 to
20 minutes
they are under care of a doctor they are taking anti-seizure medication they
understand the risk of refusing transportation and they can be released
to a responsible adult
however transport to a hospital is called for under any of the following
conditions
this is a first time seizure the patient remains unconscious for more than 20
minutes
or does not regain consciousness the seizure last longer than five minutes
a second seizure begin shortly after the first concludes the person is injured
pregnant or diabetic the seizure happened in water or the patient is
experiencing severe headache or other unusual symptoms more than 3 million
americans live with epilepsy millions more suffered seizures for other reasons
as an EMS responder
chances are you'll encounter personally they're experiencing a seizure or just
recovering from one for the patient
it can be a scary experience especially for those who had a seizure for the
first time they will look to you for reassurance and safety
armed with appropriate knowledge you'll be there to offer them answers comfort
and care
for more information on seizure recognition treatment and epilepsy visit
epilepsy.org or call 1(800)332-1000