Emergency Medicine: Seizures

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Emergency Medicine: Seizures

A seizure is a temporary abnormal electrical activity that occurs in

a group of brain cells. Often, a recurring, unprovoked seizure is

called epilepsy, but some seizures may occur in people who do not

have epilepsy. A seizure can manifest as a temporary alteration in

mental state, tonic (contraction of short muscle groups), clonic

(involuntary contractions due to sudden stretching of larger muscle

groups), movements, convulsions, and various other psychic symptoms.

Emergency medicine (action) for a seizure depends on the type of

seizure. General seizures may cause the person to fall, which may

result in an injury.

A tonic-clonic seizure results in violent movements that cannot and

should not be suppressed. The person should never be restrained, or

should there be any attempt to put something in the mouth.

Potentially sharp or dangerous objects should also be moved from the

area, so that the individual is not hurt.

After the seizure if the person is not fully conscious and alert,

they should be placed in the recovery position.

The recovery position or semi-prone position is a first aid technique

recommended for assisting people who are unconscious, or nearly so,

but are still breathing. (See: Recovery Position, below)

It is not always necessary to call an ambulance if the person is

known to have epilepsy or if the seizure is shorter than five minutes

and is typical for them, if it is not immediately followed by another

seizure, and if the person is uninjured. (When in doubt, always call

911).

A seizure longer than five minutes is a medical emergency.

A sudden fall can lead to broken bones and other injuries.

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Recovery Position

Before using the Recovery Position, perform the preliminary first aid

steps. The initial assessment should be done quickly, in a minute or

less.

First assess whether the scene is safe for the rescuer. If not,

leave. Assess whether the victim is Alert, Breathing and has

Circulation (ABCs). If the victim is alert and an adult, obtain

consent before performing first aid. For children, attempt to obtain

consent from a parent, guardian, or other responsible caregiver. If

the victim is not alert, and is not breathing, check for a pulse. If

there is no pulse, perform cardiopulmonary resuscitation. If there is

circulation, perform Rescue breathing.

Next, call 911

Rescue Breathing can include:

Mouth to mouth - This involves the rescuer making a seal between

their mouth and the patient's mouth and 'blowing', in order to pass

air in to the patient's body

Mouth to nose - In some instances, the rescuer may need or wish to

form a seal with the patient's nose. Typical reasons for this include

maxillofacial injuries, performing the procedure in water or the

remains of vomit in the mouth

Mouth to mouth and nose - Used on infants (usually up to around 1

year old), as this forms the most effective seal

Mouth to mask â€" Most organizations recommend the use of some sort of

barrier between rescuer and patient to reduce cross infection risk.

One popular type is the 'pocket mask'. This may be able to provide

higher tidal volumes than a Bag Valve Mask

-If no spinal or neck injury is indicated

The correct position is called the "lateral recovery position. Start

with the victim lying on the back and with the legs straight out.

Kneel on one side of the victim, facing the victim. Move the arm

closest to you so it is perpendicular to the body, with the elbow

flexed (perpendicular). Move the farthest arm across the body so that

the hand is resting across the torso.

Bend the leg farthest from you so the knee is elevated. Reach inside

the knee to pull the thigh toward you. Use the other arm to pull the

shoulder that is farthest from you. Roll the body toward you. Leave

the upper leg in a flexed position to stabilize the body.

-If spinal or neck injuries are possible

When the injury is apparently the result of an accidental fall,

collision or other trauma, the risk of spinal or neck injuries should

be assumed. Movement of spinal-injured victims should be minimized.

Such victims should only be moved to a recovery position when it is

necessary to drain vomit from the airway.

In such instances, the correct position is called the "HAINES

modified recovery position." HAINES is an acronym of High Arm IN

Endangered Spine. In this modification, one of the patient's arms is

raised above the head (in full abduction) to support the head and neck

First Responder Notes

If an individual has suffered a fall or injuries that suggest damage

to the spine, your priority is to keep the airway open. If breathing,

then leave them in the position you found them.

If breathing has stopped, regardless of possible injury to the

person, perform your standard checks:

DR & ABC (Danger, Response, Airway, Breathing, Circulation).

Then move them into the recovery position to open the airway. If they

do not start breathing, begin CPR. If they begin to breathe, keep

them in that position.

First Responder Priorities.

1 Breathing, everything else comes second.

2 Get Help, you are the stop gap that keeps them alive until they get

to the Hospital.

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Pacholyk, MS, L.Ac.

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