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Questions and Answers
What should be considered if upper airway obstruction does not improve after initial maneuvers?
What should be considered if upper airway obstruction does not improve after initial maneuvers?
What is a potential reason for recent vomiting and diarrhea in a patient with suspected alcohol withdrawal?
What is a potential reason for recent vomiting and diarrhea in a patient with suspected alcohol withdrawal?
Which factor increases the likelihood of glycemic control issues in a patient with chronic alcohol use?
Which factor increases the likelihood of glycemic control issues in a patient with chronic alcohol use?
At what point is it recommended to notify the hospital for proper patient treatment preparation?
At what point is it recommended to notify the hospital for proper patient treatment preparation?
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What should not be used to rule out a seizure occurrence in a patient?
What should not be used to rule out a seizure occurrence in a patient?
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What is the main concern regarding the patient's level of consciousness after the seizure?
What is the main concern regarding the patient's level of consciousness after the seizure?
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What medication allergy is documented for the patient?
What medication allergy is documented for the patient?
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How long did the seizure activity last before resolving?
How long did the seizure activity last before resolving?
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What is the patient's history of alcohol use?
What is the patient's history of alcohol use?
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What symptom was noted regarding the patient just before the seizure occurred?
What symptom was noted regarding the patient just before the seizure occurred?
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What treatment should be considered for the patient after the seizure?
What treatment should be considered for the patient after the seizure?
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What is the patient's smoking history?
What is the patient's smoking history?
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How did the patient's seizure start?
How did the patient's seizure start?
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What should be done if a patient has a generalized seizure while receiving a 15L NRB mask?
What should be done if a patient has a generalized seizure while receiving a 15L NRB mask?
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What is the appropriate action to take after observing a decreased level of consciousness in the patient?
What is the appropriate action to take after observing a decreased level of consciousness in the patient?
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What vital sign change may indicate that the patient is becoming more critical?
What vital sign change may indicate that the patient is becoming more critical?
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If more breathing attempts than chest rise are observed, what does this signify?
If more breathing attempts than chest rise are observed, what does this signify?
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What should be monitored closely when a patient shows snoring much louder than before?
What should be monitored closely when a patient shows snoring much louder than before?
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What is the heart rate recorded in the vital signs?
What is the heart rate recorded in the vital signs?
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What could be the potential reason for the patient's snoring if they are supine?
What could be the potential reason for the patient's snoring if they are supine?
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What does the presence of blood in the mouth and a wound on the tongue suggest?
What does the presence of blood in the mouth and a wound on the tongue suggest?
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What is the significance of a non-diagnostic 12-lead ECG with no ST changes?
What is the significance of a non-diagnostic 12-lead ECG with no ST changes?
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What respiratory findings were noted upon examination of the chest?
What respiratory findings were noted upon examination of the chest?
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What was the recorded systolic blood pressure (BP) in the vital signs?
What was the recorded systolic blood pressure (BP) in the vital signs?
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What was the patient's oxygen saturation level as indicated in the vital signs?
What was the patient's oxygen saturation level as indicated in the vital signs?
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What was the recorded end-tidal carbon dioxide (ETCO2) level?
What was the recorded end-tidal carbon dioxide (ETCO2) level?
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What type of breath sounds were noted in the lung fields?
What type of breath sounds were noted in the lung fields?
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Which vital sign indicates the patient is experiencing tachycardia?
Which vital sign indicates the patient is experiencing tachycardia?
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What was observed regarding the patient's abdomen?
What was observed regarding the patient's abdomen?
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How did the patient respond to commands during the extremities examination?
How did the patient respond to commands during the extremities examination?
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What was the patient’s oxygen saturation level?
What was the patient’s oxygen saturation level?
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What condition was noted in the pelvic examination?
What condition was noted in the pelvic examination?
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What is indicated by the patient's blood pressure reading of 153/86?
What is indicated by the patient's blood pressure reading of 153/86?
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What finding was noted when auscultating the back?
What finding was noted when auscultating the back?
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What was the duration of the patient's seizure before it ceased?
What was the duration of the patient's seizure before it ceased?
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What position was the patient found in when responders arrived?
What position was the patient found in when responders arrived?
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What is the significance of the patient not having head or neck trauma during the seizure?
What is the significance of the patient not having head or neck trauma during the seizure?
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Which symptom indicates the patient's decreased level of consciousness post-seizure?
Which symptom indicates the patient's decreased level of consciousness post-seizure?
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What does a dusky skin color indicate in this patient?
What does a dusky skin color indicate in this patient?
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What precaution is suggested upon identifying the patient's seizure history and decreased level of consciousness?
What precaution is suggested upon identifying the patient's seizure history and decreased level of consciousness?
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What type of seizure did the patient experience?
What type of seizure did the patient experience?
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What does the staff's description of the patient starting to seize while standing imply about the seizure's onset?
What does the staff's description of the patient starting to seize while standing imply about the seizure's onset?
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Study Notes
Neuro Scenario #6 Seizure
- Patient Information: 48-year-old male, experiencing a seizure at a non-medical alcohol rehabilitation facility.
- Seizure Duration: 6 minutes, "grand mal" type.
- Initial Assessment: Seizure stopped, no head or neck trauma reported by bystanders.
- Personal Protective Equipment (PPE): Universal precautions, consider droplet/contact.
- Scene Time: 1 PM.
- Environment: Summer, early afternoon, cafeteria.
- Hazards: None apparent.
- Number of patients: 1.
- Additional Resources: Consider medical back-up (ambulance or fire).
- Mechanism of Injury/Illness: Seizure.
Scene/Bystander Information
- Staff Member: Observing, directs patient to cafeteria, lands on buttock then ground.
- Position: Lying in recovery position on the ground, head supported by a blanket, staff member kneeling beside.
- Level of Activity/Distress: Eyes closed, spontaneous respirations.
- Skin Color/Condition: Dusky, warm, diaphoretic.
Initial Approach
- C-spine: Not required, but if applied, patient snoring noted when rolled on back.
- Level of Consciousness (LOC): Eyes closed, no response to verbal or gentle stimuli.
- Moans/Speech: Incomprehensible speech to painful stimuli, starts coughing with frothy sputum. Does not obey commands.
Airway, Breathing, and Circulation (ABCs)
- Airway: Patent, small to moderate amount of frothy sputum noted, intermittent snoring respirations.
- Airway Intervention: Consider suction, manual maneuvers, or NPA if appropriate.
- Breathing: 24/min, adequate chest rise with deep spontaneous respirations. Supplemental oxygen (N/C or NRB) may be considered.
- Circulation: Radial pulse present, regular at 124/min.
Vital Signs
- Vitals (if applicable): BP, HR, RR, O2 saturation, temperature, blood glucose.
- Important Note: The exact vital signs often need to be recorded at the scene and reviewed throughout treatment/reassessment.
Rapid Survey
- Head: No remarkable findings, if asked for: no tracheal deviation, mild JVD bilaterally.
- Neck: No remarkable findings, no tenderness.
- Chest: Breath sounds present to all lung fields with mild expiratory wheezes.
- Abdomen: Soft. Exam done if requested/asked by others
- Pelvis: No remarkable findings.
- Extremities: Upper and lower extremities circulation intact.
- Back: No remarkable findings. Breathable sounds clear throughout lung fields.
Other Considerations
- Blood in the mouth: Potential from generalized seizures (not always present), important to log.
- Urinary/Bowel Incontinence: Possible with seizures, but may not be observed in all cases.
Delegated Information
- Patient History: Facility staff will provide information, if possible, about the patient's medical history, medications, alcohol use, smoking status, last meal, and last drink.
- Family History: If possible, family history is taken into account.
Differential Diagnoses
- Seizure: Common reason for the patient's symptoms.
- Other neurological conditions: Brain tumor, CVA, or other possible conditions can be considered.
- Intoxication: Alcohol withdrawal or other potential substances are possible.
Treatment and Reassessment
- Ongoing Assessments: Continuous monitoring of the patient's condition is vital. Vital signs are reviewed frequently and recorded.
- Treatment: Medication and interventions may be required dependent on the patient's condition.
- Hospital notification: Notification of the hospital may be required, for example, for appropriate medical attention.
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Description
This quiz explores the management and assessment of a patient experiencing a grand mal seizure in a rehabilitation setting. Participants will evaluate the scene, the role of bystanders, and considerations for patient safety and care during a seizure incident.
