Prehospital Academy Lesson 18.5
Neurologic Emergencies: Seizures
This lesson provides a comprehensive overview of seizures, a common and often frightening neurological emergency encountered by EMS providers. A seizure is a neurological episode caused by a surge of abnormal electrical activity in the brain. Understanding the different types of seizures, their phases, and the appropriate management is crucial for providing safe and effective care. This section aims to build confidence in recognizing and managing these events.
Defining Seizures: A Surge of Electrical Activity
A seizure is not a disease in itself but a sign of an underlying neurological issue. It results from a sudden, uncontrolled electrical disturbance in the brain. The presentation of a seizure can vary widely depending on the location and extent of this electrical activity.
Types of Seizures
Seizures are generally categorized into two main groups: generalized and focal.
Generalized Seizures
These seizures result from electrical discharges affecting large areas of the brain on both sides.
Tonic-Clonic (formerly Grand Mal): This is the most widely recognized type of seizure, characterized by unconsciousness and generalized, severe twitching of all muscles. It typically involves a tonic phase (stiffening of the body) followed by a clonic phase (violent jerking). This type of seizure can last for several minutes.
Absence (formerly Petit Mal): Involves a brief lapse of consciousness, often with staring into space or rapid eye blinking. The patient is typically unaware of the seizure.
Focal (or Partial) Seizures
These seizures originate in a specific, narrow area of the brain.
Simple Focal: The patient remains conscious and may experience unusual sensations or movements in a specific part of the body.
Complex Focal: The patient has an altered level of consciousness and may exhibit repetitive behaviors like lip-smacking or fumbling with their clothing. They are generally unaware of their actions during the seizure.
Phases of a Seizure
A seizure can be broken down into several phases:
Aura: A warning sensation experienced by some individuals before a seizure, which can include unusual smells, sights, or feelings.
Ictal Phase: The period of active seizure activity, from the first symptom to the end of the seizure.
Postictal Phase: The period of recovery after the seizure. The patient may be confused, drowsy, combative, or have a headache. This phase can last from minutes to hours.
Status Epilepticus: A Neurological Emergency
Status epilepticus is defined as a seizure that lasts longer than 5 minutes, or when seizures occur consecutively without the patient regaining consciousness between them. This is a life-threatening emergency that requires immediate and aggressive intervention to prevent permanent brain damage or death.
Assessment and Management of Seizures
Prehospital management of seizures focuses on patient safety and supportive care.
Assessment:
Scene Safety: Ensure the environment is safe for the patient and providers.
Primary Assessment (ABCs): During a seizure, the airway can be compromised. Pay close attention to the patient's breathing.
Observation: Note the type of seizure activity, the parts of the body involved, and the duration of the ictal phase.
History: Inquire about a history of seizures, medication compliance, recent illness or injury, and any known triggers.
Postictal Assessment: Once the seizure has stopped, perform a full assessment, including vital signs and blood glucose level, as hypoglycemia can cause seizures.
Management:
During the Seizure:
Protect the patient from injury by moving objects away from them.
Loosen any restrictive clothing.
Do NOT place anything in the patient's mouth.
Position the patient on their side if possible to allow secretions to drain from the mouth.
After the Seizure (Postictal Care):
Maintain a patent airway. Be prepared to suction.
Administer high-flow oxygen.
Provide emotional support and reorient the patient as they become more aware.
Transport the patient for further medical evaluation, especially if it is their first seizure, they are pregnant, or the seizure was caused by an injury.
Critical Thinking Questions
You arrive to find a patient actively experiencing a tonic-clonic seizure. What are your immediate priorities for managing this patient's safety during the ictal phase?
Differentiate between a simple focal seizure and a complex focal seizure. How would your assessment and interaction with the patient differ for each type?
A patient has a 10-minute seizure that stops just as you arrive. They are now unresponsive and breathing slowly. Describe your immediate interventions and the rationale behind them.
Why is it crucial to perform a blood glucose check on all patients who have had a seizure, even if they have a known seizure disorder?
You are transporting a patient in the postictal phase who is confused and agitated. What communication strategies can you use to de-escalate the situation and provide reassurance?