[Surgicalcric]

EMS should be summoned for all the scenarios. You should never take a 'wait and see' position even with persons who have a history of epilepsy or other seizure history. Remember, when a person is seizing they are not breathing and if they seize long enough they will arrest from hypoxia. Better to have them on the way then not and the patient arrest. Also, unless you know the origin of the seizure the patient will require evaluation by a MD to determine the cause. NEVER wait, bad things happen when people wait. (sorry Sacamuelas)

Other than protective care there is nothing the layperson can do to treat the seizure once active. Once the seizure itself is addressed or has ended in the case of the layperson you would treat the Cause which leads me to the questions posed by our resident Dental Care Professional.

Remember, in the prehospital setting, determining the origin of the seizure activity is less important than managing the complications and recognizing whether the seizure is reversible with therapy. Some of the more common causes, and their clinical presentations as seen, in the pre-hospital setting, are:


Stroke AKA Cerebrovascular Accident- hemiparalysis; unequal pupil size or lack of pupillary response on one side; slurred speech; dizziness; abnormal respiratory pattern (Cheyne-Stokes, hyperventilation, Ataxic, Diaphragmatic breathing, Apneustic respirations); increased ICP as evidenced by Cushing’s Triad; significant PMH to include but not limited to: HTN, Diabetes Mellitus, previous CVA.

Trauma(head)- Physical presentation of trauma; recent history of trauma; increased ICP (Cushing's Triad).

Poisoning, including ETOH- signs of poisoning if animal/insect induced (bites, stings). Lethargy, confusion, N&V, abdominal pain, blurred vision, tachypnea, shortness of breath, and/or witnessed ingestion with ingested toxins. Red flushed skin, hx of abuse, hx of recent use, signs of use with ETOH poisoning.

Hypoxia- cyanosis; diaphoresis; low SAO2; low ETCO2; hx of chronic pulmonary disease (COPD, Asthma, Emphysema, Bronchitis); anxiety prior to seizure activity

Hypoglycemia (low BGL)- diaphoresis; hx of diabetes mellitus; altered mental status prior to seizure; low Blood Glucose Level

Infection- Hx of recent surgical procedure; warm flushed skin over/near surgical site

Brain Tumor- history of tumor; see Stroke for other S/S.

Drug Overdose- Signs of overdose; hx of drug use/abuse.

Eclampsia- Hx or presentation of gestational hypertension

Metabolic abnormalities- hx of metabolic problems (anorexia, diabetic ketoacidosis, Thiamine deficiency, kidney or liver failure)

Most of the symptoms above will need to be noted prior to onset of seizure. The postictal state that follows the seizure will mimic many of the S/S of the above disease processes.