An emt’s guide to seizures! By: Danielle & Chris
Seizure? What’s that? A seizure, or convulsion, is a temporary alteration in behavior or consciousness. In Layman’s terms, a seizure, is a temporary loss of bodily control or consciousness. Which also can be followed by muscular twitching.
Types of Seizures Generalized Seizure: (grand mal seizure) The most common seizure is a seizure typically characterized by unconsciousness and twitching of all the body’s muscles. Lasting several minutes or longer. Absence Seizure: (petit mal seizure) is typically characterized by lip smacking, Eye blinking, or isolated convulsions or jerking of the body. More often, this type of seizure occurs in children ages 4 to 12 years old. *Graph not calculated on actual figures*
Did you know!? In Ancient Babylon, more than 3,000 years ago. One of the superstition's believed at the time was that anyone who underwent a seizure were being visited by demons or gods!
Some seizures may only occur on one side of the body. While others begin on one side and gradually progress to a Generalized Seizure. Signs & Symptoms of a Seizure Before a seizure, a patient may experience a warning also known as an aura. An aura, can be any of the following. A strange light, an unpleasant smell, confusing thoughts or experiences. All of which are possible that the patient may encounter. The patient may also experience a tonic phase, in which there will be a period of extensor muscle tone activity, tongue biting, or bladder or bowel incontinence. (The extensor muscles are the muscles that extends or straightens a body part.) During the tonic-clonic phase the patient may show bilateral movement characterized by, muscle rigidity and relaxation usually lasting 1 to 3 minutes. During the tonic-clonic phase the patient exhibits, tachycardia, Hyperventilation, and intense salivation.
In case you forgot!! Tachycardia: Heart rate (pulse)that is greater than 100 beats/min. *For adults* Hyperventilation: Overbreathing to the point that the level of arterial carbon dioxide falls below normal. Intense Salivation: An abnormally abundant flow of saliva.
Signs & Symptoms(continued) Most seizures last 3 to 5 minutes and are followed by a period of 5 to 30 minutes, called a postictal state. The postictal state is almost like the rebooting of a computer, after the Patient finishes the seizure they are unresponsive at first, but gradually regain consciousness. The postictal state is over when the patient regains a complete level of consciousness. Seizures that continue every few minutes without regaining consciousness or last longer than 30 minutes are referred to as status epilepticus, aka status seizures. And should be considered potentially life threatening situations because emergency care is needed.
Did you know!? In the early 19th century, people who had severe epilepsy and people with psychiatric disorders were cared for in asylums, but the two groups were kept separated because seizures were thought to be contagious!”
Causes of Seizures Some seizure disorders, such as epilepsy, are congential. (Meaning the patient was born with the condition.) Other types of seizures may be due to high fevers, structural problems in the brain, metabolic or chemical problems in the body. Epileptic seizures can usually be controlled with medications, but if the patient does not take their medications, or take the prescribed dose they will often have seizures. Ex. Of Medications would be Dilantin, Phenobarbital, and Tegretol. Seizures may also be caused by brain abnormalities (tumors, infection, scar tissue), abnormal levels of of certain blood chemicals (hypoglycemia, drug over doses, poisons). Seizures caused by sudden high fevers are known as febrile seizures, and typically occur in children. Though unnerving for parents, these seizures are generally well tolerated by the child.
The Importance of Recognizing Seizures It is important that you are able to recognize when a seizure is occurring or whether one has already happened.. In addition to recognizing that seizure activity has occurred and/or that something different is happening, you must also recognize the postictal state as well as other complications of seizures. Because most seizures involve muscle twitching and spasms, the muscle uses a lot of oxygen and in turn a build up of acid forms in the bloodstream, Seizures often prevent patients from breathing normally, making the problem worse. As blood glucose levels drop, patients with diabetes should be closely monitored.
The Importance of Recognizing Seizures (continued) Not all seizures are congential!! Recognize that seizure activity may also be caused or associated with other underlying issues. (eg. The patient falling during a seizure causing head/bodily trauma.) Patients having a generalized seizure may experience incontinence, meaning that they may lose bowel and bladder control. So look for that as a clue in unresponsive patients to see if they possibly experienced a seizure and watch where you step! Do what you can to ease the embarrassment of the patient and also ensure them that incontinence is a part of the loss of control from a seizure.
The Postictal State Once a patient is oriented to person, place and time, the postictal state is typically over. The postictal state may be characterized by hemiparesis, or weakness on one side of the body. Unlike the typical stoke , hypoxic hemiparesis soon resolves itself. The postictal state is characterized by lethargy (fatigue) and confusion to the point that the patient may be combative and appear angry. So be prepared for worst case scenarios! If the patients condition does not improve, consider other possible underlying problems, including hypoglycemia or infection.
Assessing the Seizure Patient In most cases, you will be called to care for a patient who has already had a seizure. Or you may respond to a patient who is found in the postictal state. In other situations you may also find patients who are having seizures but also have some other medical problem, such as cardiac arrest, or their a nut case (psychological problem). THOROUGH assessment at the scene and once ambulatory is key in order for the hospital staff to care for the patient effectively.
Did you know!? The same medicines used to treat seizures in humans is also used in canines!”
Interventions of an EMT! Being that most seizures are have a limited time in which they last, they may not require a lot of intervention because it may be over by the time of arrival. For those who are actively seizing, protect them from harm, maintain a clear airway by suctioning as needed, and provide oxygen as quickly as possible! Transport as quickly as possibly to the hospital, and if the option is available, meet up with ALS.
Definitive Care for a Patient Who Has Had a Seizure In most cases , patients who have had a seizure require definitive treatment in the hospital. Even if the patient has a history of seizures that is being controlled by medications. Depending on protocols, assess and treat the patient for possible hypoglycemia. If trauma is suspected, provide C-Spine immobilization. And manage that airway! For a child with a suspected febrile seizure, you may attempt to cool them down by removing their clothing and cooling the child with water and fan the areas. Be patient, kind and show tolerance. A seizure is not an easy thing to go through and the patient may be confused and possibly afraid.
Review time!! What is the main type of seizure experienced? A. Stroke B. Generalized Seizure C. Car Accident D. Decapitation
B! Generalized Seizure (grand mal seizure) The most common seizure is a seizure typically characterized by unconsciousness and twitching of all the body’s muscles. Lasting several minutes or longer. If you guessed A, C or D. Well I just don’t know what to say.
Review time!! Most seizures last about how long? A. 1 year B. 3 to 5 minutes C. 5 seconds D. 2 years
B! Most seizures last 3 to 5 minutes and are followed by a period of 5 to 30 minutes, called a postictal state.
REVIEW time!! What type of seizure mostly occurs in children? A. Myocardial Infarction B. Febrile Seizures C. Metabolic Seizures D. Pulmonary Edema
B! Seizures caused by sudden high fevers are known as febrile seizures, and typically occur in children. Though unnerving for parents, these seizures are generally well tolerated by the child.
Review time!! What's my favorite color? A. Red B. Blue C. Orange D. Green
D! Green! And I bet you guys all picked B for blue. THE END