A seizure is the result of abnormal and sudden electrical activity in the brain that can be caused by a wide range of conditions. Seizures can be a symptom of an underlying acute medical or neurological condition, or they can lack a clear etiology (as in the case of epilepsy). The main goals of seizure management are to stop the seizure, protect the patient from secondary injury such as aspiration or trauma, evaluate for and treat potentially reversible causes, and provide safe, expeditious conveyance to hospital.
Essentials
Seizures can be traumatizing for bystanders and family. First-time seizures are particularly disturbing.
Benzodiazepines are the first line therapy for active seizures.
Consider important causes of seizures:
Hypoglycemia
Hypoxia
Traumatic head injury
Drug overdose, intoxication, or withdrawal
Exposure to toxic substances
Electrolyte disturbances
Cerebrovascular accidents
Infections and fevers, including infectious of the central nervous system
Care more specifically for the patient than the patient’s seizures
For women who are, or who may be pregnant, consider the role of eclampsia
Protection of the airway and maintenance of effective oxygenation and ventilation is of critical importance. Profound hypoxia can develop in patients with prolonged seizure activity.
As a general rule, paramedics should consider controlling seizures in patients who continue to seize after their arrival on-scene. Taking travel time into consideration, these patients are often seizing for upwards of ten minutes by the time an ambulance crew makes contact.
Patients with known seizure disorders are often prescribed benzodiazepines to be administered by family or caregivers. Paramedics must be aware of this possibility and adjust their dosing strategies accordingly.
Do not provide prophylactic benzodiazepines to patients who are not currently seizing.
The duration of the postictal phase is often variable. Patients may exhibit a wide range of behaviors, none of which are intentional and none of which should prompt intervention from law enforcement. Wherever possible, paramedics and EMRs/FRs should provide patients with a quiet, non-stimulating space to recover from their seizure, while protecting them from further harm.
Referral Information
Patients with well-established seizure disorders who experience a single, self-limited seizure, may wish to decline conveyance to hospital.