Neuro Scenario #6: Seizure Management

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.