A Guide to Seizure Management for Emergency Medical Responders

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


  1. Do we turn the people on the side so that the breathing is okay and
    nothing goes in the lungs, after the convulsions have stopped or during
    the convulsions?

  2. This is truly a very well constructed, informative video about seizures. Thumbs up for the creator.

  3. My partner has epilepsy. He has absence seizures and tonic clonic and disorienting stage after the tonic clonic.

  4. my friend is having a seizure(hes well known for years) and hes having one NOW in a voice chat and its worrying, hes moaning and sounds drunk/slow and its freaking me the fuck out (also had a coworker do it and that was the first time i experienced it

  5. Please help an amazing young man get his last surgery (Epilepsy VNS Device Removal) so he can enlist in the Army.

  6. i have always wondered if i had and continue to have seizures – before one of these things i often get weird smells some quite strong and not related to anything around me – i can get visual weirdness like tunnel vision or just not right – my voice starts to sound really squeaky up to a couple of hours before this happens – i can blank out – have fallen down but now try to get down onto something – apparently my head can twitch sometimes other times i blink a lot – i can feel like i am asleep yet awake and cant move – and both bowels and bladder have been known to empty totally – embarrassing to the extreme – my doctor has said i am just dehydrated – these sessions can be spaced well apart or i can have a couple a day – they last about 2 minutes??? – i am extremely tired after these moments – and my speech sounds slurred to me – i have had a head injury about 2.5 years ago and wonder if it is all connected

  7. Great video. My brother has seizures. He is blind and doesn't talk with very limited sign language . So Im trying to learn more about them.Thank you !

  8. I had four yesterday. I used to have them regularly. Haven't had one since 2015. Just had four in one day. Started a new med. It causes me to hurt all over in my muscles and bones. Now I'm tired and sleepy. I do not do drugs. I do have mitrovalve prolapse and a heart murmur.

  9. @5:02 I just had a grand mal or general tonic clonic seizure a few days ago. I wish someone would have shoved a cloth or something in my mouth, as I nearly bit my tongue off. It is split deeply in several places and purple and blue in others. It's been days, and I still can barely stand the pain of eating!

  10. My dad died from a grand mah. He had them alot and one day he went to bed, i woke up to being told he died in his bed as they found him face down arms wide open as if he was falling down and he tried to put his hands out bc he knew he was falling down or something. Sad. Miss him.

  11. I have epilepsy so I have Seizures πŸ˜πŸ˜œπŸ‘»πŸ€—πŸ‰πŸŒΈπŸͺπŸ¬πŸ‡πŸ’©πŸ§€πŸ’πŸŒΆπŸ—πŸ₯žπŸ₯œπŸ₯‘πŸ“πŸπŸ¬πŸ«πŸ©πŸ°

  12. Wrong. You turn persin on the side when attack is over, only if she has something in Her mouth, you turn Her right at begin

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