3. MEDICAL EMERGENCIES
3.10 SEIZURES
A seizure is a temporary alteration in behavior due to the massive electrical discharge of one or more groups of neurons in the brain. Seizures can present in several different forms: generalized or grand mal seizure, partial/ simple, partial/complex or petit mal seizure. The single most common cause of seizure disorder is idiopathic epilepsy. However, there are multiple other causes: alcohol abuse, hypoglycemia, head trauma, vascular disorders, cerebrovascular accidents, overdose, infection, psychiatric, electrolyte abnormalities, eclampsia, hypoxemia, toxic exposure, drug withdrawal and structural brain disorders such as tumors. The seizure may be followed by a post-ictal state or complete coma depending upon cause.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. Consider nasopharyngeal airway. Protect patient from injury and secure airway as opportunity arises.
3. Administer high concentration of oxygen via non-rebreather mask once seizure has abated. Be certain that the oropharynx is clear of secretions and/or vomitus.
4. Obtain appropriate history related to event, including Past Medical History, Medications, Drug allergies, Substance abuse or Trauma. Question all witnesses or bystanders as to actual event.
5. The majority of seizures are self-limiting, followed by a gradual awakening. However, prolonged or recurrent seizures may indicate status epilepticus. (see below)
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. In cases of suspected head/neck injury, assure cervical spine immobilization.
3. Maintain an open airway and assist ventilations as needed. Consider nasopharyngeal airway. Protect patient from injury and secure airway as opportunity arises.
4. Administer high concentration of oxygen via non-rebreather mask once seizure has abated. Be certain that the oropharynx is clear of secretions and/or vomitus.
5. If patient is a known diabetic who is conscious and can speak and swallow, give oral glucose or other sugar source as tolerated. CAUTION: Do NOT administer anything orally if the patient d oes not have a reasonable Level of Consciousness and normal gag reflex.
6. Activate ALS intercept, if deemed necessary and if available.
7. Initiate transport as soon as possible with or without ALS.
8. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. In cases of suspected head/neck injury, assure cervical spine immobilization.
3. Maintain an open airway and assist ventilations as needed. Consider nasopharyngeal airway. Protect patient from injury and secure airway as opportunity arises.
4. Administer high concentration of oxygen via non-rebreather mask once seizure has abated. Be certain that the oropharynx is clear of secretions and/or vomitus.
5. If patient is a known diabetic who is conscious and can speak and swallow, give oral glucose or other sugar source as tolerated. CAUTION: Do NOT administer anything orally if the patient does not have a reasonable level of consciousness and normal gag reflex.
6. Activate Paramedic intercept, if deemed necessary and if available.
7. ALS STANDING ORDERS:
a. Provide advanced airway management (if indicated).
b. Initiate IV Normal Saline while en route.
8. Initiate transport as soon as possible with or without Paramedics.
9. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. In cases of suspected head/neck injury, assure cervical spine immobilization.
3. Maintain an open airway and assist ventilations as needed. Consider nasopharyngeal airway. Protect patient from injury and secure airway as opportunity arises.
4. Administer high concentration of oxygen via non-rebreather mask once seizure has abated. Be certain that the oropharynx is clear of secretions and/or vomitus.
5. ALS STANDING ORDERS
a. Provide advanced airway management (if indicated).
b. Initiate IV Normal Saline (KVO).
c. Cardiac Monitor: manage dysrhythmias per protocol.
d. If obvious narcotic overdose:
- Narcan 0.4-2.0 mg IV Push, IM, SQ or ET.
e. Thiamine 100 mg IV or IM (in patient with obvious alcohol abuse, malnourished state )
f. Determine Blood Glucose level:
- If glucose is greater than 100 mg/dL, Glucose administration unnecessary.
- If glucose is less than 100 mg/dL, administer Dextrose 50%, 25 grams IV Push.
- CAUTION: If cerebrovascular accident is suspected, contact Medical Control prior to administration.
g. If patient is in status epilepticus, administer the following:
- Valium (Diazepam) 5 mg - 10 mg slow IV push.
h. If no IV access, administer Glucagon 1-2 mg IM for suspected/known hypoglycemia.
6. Initiate transport as soon as possible.
7. Contact MEDICAL CONTROL. The following may be ordered:
a. For status epilepticus:
- Valium (Diazepam) 5 mg - 10 mg slow IV push.
- Ativan (Lorazepam) 2 mg - 4 mg slow IV push or IM.
- CAUTION: In patients with head injury or hypotension, the use of Valium and/or Ativan may be contraindicated.
b. Additional Dextrose 50% IV push.
c. Narcan 0.4 - 2.0 mg IV push, IM or ET.
d. Magnesium Sulfate 1-4 grams IV over three (3) minutes if suspect eclampsia of pregnancy.
8. Notify receiving hospital.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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