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Seizure (optional)

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Now, let's cover seizures for the adult in what to do when it happens in the workplace. So, when a person goes into a seizure, they could have gone into that for so many different reasons its unbelievable. So, to focus on why it happened is not the bigger point, the fact is, is recognizing that it did happen. We saw that she went into what we call a tonic state, hands were gripped, they were pointed towards her body, she was seizing actively, and then went into what we call a postictal state or a relaxed recovery state. While the patient is actually seizing, its important to do a few things. Make sure that whatever is around them is not going to actually harm them more. So, if there are sharp objects that they can actually bump into when they were seizing, we want to either move the object or either move the patient, so that they don't get her further. If they seem to be having what we call a tonic clonic seizure where their contracting and relaxing, contracting and relaxing, they might be hanging their head on a hard surface like a cement floor. It is important for us to protect their head which we can do by cupping their hands to just give them a little cushion in, so that while they're actively seizing, they're not also causing a head injury. Now, once a patient has come out of seizure, we need to assess a couple things. One, has EMS been activated? As soon as we see that they are in a seizure, and we don't know that there is an ongoing epileptic they don't have any standing rules, we're gonna call 911. But if we are near the patient, and we can send somebody to do that, we will be using that time down to assess them for whether or not they're breathing, or whether they are moving and beginning to come back to consciousness. If this patient is not breathing and not moving, and doesn't respond to our taps and shouts, we're gonna go right into the CPR and call for an AED. If this person starts to breathe which is fairly normal during the postictal state, we're going to assess them to see is this agonal respiration's or are they breathing more in a corrective measure. If they are beginning to breathe, then we're gonna go ahead and do the recovery position to help them keep their airway opening clear while they recover from the seizure, and we wait for EMS to arrive. The way that we do this is we elevate the arm closest to us up over their head. We bring the farthest leg away over, and we cross their legs. Grabbing their wrist in their hip underneath their head and neck, we roll the patient onto their side. We lift their head, untuck their hand, and bend their arm up underneath their head. Notice how they now have a face that's pointing towards the ground, allowing gravity to help clear their airway. We then bring their knee up as a kickstand to help protect them all the way over. If they seem to be showing signs of shock, like cool, pale, sweaty, rapid pulse, we can cover them with a sheet quarter blanket, and allow them to recover. While we're waiting for EMS to arrive, we're gonna be assessing for breathing and for recovery, a sign maybe they're talking to us, maybe they're saying what happened, maybe they're saying oh my head really hurts, but any of that stuff is good signs, that they're recovering out of the seizure. Make sure you understand that a seizure patient is low on oxygen, they're confused, they had an electrical storm in their brain, and they might be confused, they could even be combative, they might wanna try to get up, they don't know where they're at, and that can last for a few minutes. So just don't try to hold them them down during a seizure, don't stop them from seizing, just help support them and protect them during the seizure, and help protect them for more serious situations like cardiac arrest while we await EMS to arrive.

In this lesson, you'll learn how to treat an adult patient who goes into a seizure or has just come out of one.

A person can go into a seizure for too many reasons to mention. As you are concerned, why it happened isn't important. Being able to recognize that it did happen is the key.

For you to know if a seizure took place, ideally you or someone else saw the patient go into a tonic state that exhibited the following signs:

  • Hands are gripped and pointed inward
  • The patient is actively seizing
  • The patient ends the seizure in the postictal state (relaxed recovery)

How to Treat a Patient who is Actively Seizing

There are a few important things that you can do when a person is suffering from a seizure to help protect them from further harm. First, is there anything around the patient that could injure them, such as sharp objects? If there is, remove the threat from the scene or move the patient to a safer area.

If the patient is having a zootomic clonic seizure – in which they are fluctuating between contracting and relaxing – they could bang their head on the ground. To protect their head, simply cup your hands together and place them underneath the patient's head.

Warning: Never hold down a seizing patient or try to stop the seizure in any way. Just support and protect the patient during the seizure. Then, once the seizure is over, assess for more serious situations like cardiac arrest.

How to Treat a Patient after a Seizure

Pro Tip #1: There are several things to do post-seizure, but the most important is calling 911 and activating EMS if it hasn't already been done. As soon as you determined that the patient had a seizure, and you don't know if the patient is an ongoing epileptic, call 911 immediately.

After EMS has been activated, begin to assess the patient for a couple of things.

Is the patient moving and breathing normally again?

Are they beginning to return to consciousness?

If the patient isn't moving or breathing normally, and isn't responsive to your taps and shouts, go right into CPR and retrieve or find an AED.

If the patient is beginning to breathe normally again, does the breathing appear to be agonal respirations or more corrective breathing? To help keep the patient's airway open and clear, put them into the following recovery position.

  • Elevate the arm closest to you and bring it up over the patient's head before placing it on the ground.
  • Bring the patient's furthest leg over their other leg so that their legs are crossed.
  • Grab the wrist of the furthest arm and the hip together, while placing your other hand under the head and neck and roll the patient toward you and onto their side.
  • Support the head while you place the patient's outstretched arm under their own head and with the chin pointing down, allowing gravity to help clear the airway.
  • Bend the patient's top leg to a 90-degree angle at the knee, essentially creating a kickstand to help protect the patient from rolling over.

Pro Tip #2: A person who has just experienced a seizure – essentially an electrical storm in the brain – will be low on oxygen. As a result, they may be confused or combative and this will likely last a few minutes.

While waiting for EMS to arrive, continue to assess the patient for breathing and recovery signs, like talking. Any signs that the patient is becoming more responsive are good signs.

If the patient begins showing signs of shock – cool, pale, sweaty skin and a rapid pulse – cover him or her with a sheet, coat, or blanket and keep them as warm and comfortable as possible while waiting for EMS to arrive.

A Word About Pediatric Seizures

A seizure is a disorder in the brain's electrical system, which is sometimes marked by loss of consciousness and often by uncontrollable muscle movement, also referred to as convulsions.

In children, febrile seizures are the most common type of seizure. These seizures occur with a rapidly-rising or excessively-high fever, typically higher than 102° F. Children with febrile seizures may exhibit some or all of the following signs and symptoms:

  • Sudden rise in body temperature
  • Jerking of the head and limbs
  • Loss of bladder or bowel control
  • Confusion
  • Drowsiness
  • Crying out
  • Becoming rigid
  • Holding the breath
  • Rolling the eyes upward

To assess what type of seizure the child has had and why, it's important to ask good questions:

  • Has the child ever had seizures before? If so, is the child on medications for them? If not, is there a family history of seizures?
  • Does the child have diabetes? If so, what type of insulin/medication is being used and when was the last time it was given?
  • Has the child started taking any new medications lately? If the child takes medications, is it possible there may have been an overdose? Could the child have taken someone else's medication by accident?
  • Could the child have ingested anything poisonous?
  • Has the child had a recent injury, particularly a head trauma?
  • Has the child seemed sick or had a high fever, stiff neck, or headaches?
  • What did the seizure look like? Did it involve the child's whole body, or only one half of the body?
  • Did it start in one area and progress to the rest?
  • Did the child fall when the seizure began and if so, was it possible the child's head struck an object or the floor?

These are just some of the questions you can use to help decipher what type of seizure the child had and why.