Treating Seizures And Convulsions

"He gets these 'fits' every so often. The doctor told him to take his medications but he forgets.....especially when he's drinking. The only thing that bothers me is that he seems to stop breathing when he's in one of his fits."

Seizures are characterized by random shaking movements which may involve the entire body. Seizures usually last less than one minute but may recur several times.

Seizures (convulsions) can be caused by several factors:

  • Epilepsy
  • Trauma
  • Stroke
  • Insulin shock
  • High fever
  • Drug overdose

Patients are usually unconscious during seizures and do not remember them afterward. They may have lost bowel and/or bladder control, soiling their clothing.

After a seizure, the patient may be sleepy, confused, upset, hostile or out of touch with reality for up to an hour. You must monitor the patient's ABCs and arrange for transport to an appropriate medical facility.

Seizures often end before you arrive. If they have not ended, your treatment during a seizure consists of protecting the patient from injury. During a seizure, the head may strike the floor, and the arms and elbows may hit hard enough to produce a fracture.

To prevent these injuries, place your feet under the head to keep it from hitting the floor or ground, and hold the wrists to control the movement of the arms and protect the elbows. At no time should you actually restrain the patient's movements. If you attempt to, you may cause further injury. The patient should only be moved if he or she is in a dangerous location, such as in a busy street or close to something hard, hot or sharp. CAUTION: Do not attempt to put anything in the patient's mouth.

During a seizure, the patient generally does not breathe, and turns blue. You cannot do anything about the patient's airway during the seizure but once it has stopped, it is essential that you ensure an open airway. This is usually best accomplished with the head-tilt method. After you have opened the airway, lie the patient on his or her side so any secretions (saliva or blood from a bitten tongue) can drain out. Most patients start to breathe soon after the seizure has ended. If the patient does not resume breathing after a seizure, begin mouth-to-mouth or mouth-to-mask breathing.

Most patients are confused after a seizure and may become anxious, hostile and belligerent. At this point, the patient needs privacy. Because the person is probably embarrassed about what happened and where it happened (perhaps in a public place, such as a restaurant or shopping mall), move the patient to a more comfortable, private place for 30 to 45 minutes. Do not leave the patient. Every patient who suffers a seizure should be encouraged to go to a medical facility for examination and treatment.

Seizures In Children

Seizures (convulsions) in children can result from high fever or from disorders such as epilepsy. Each seizure can vary in intensity from simple, momentary, staring spells (without body movements) to generalized seizures in which the entire body stiffens and shakes severely.

While seizures can be frightening to parents, bystanders and rescuers, they are not usually dangerous. During a seizure, a child loses consciousness, the eyes roll back, the teeth become clenched and the body is shaken by severe jerking movements. Often, the child's skin becomes pale or turns blue. Sometimes, the child will lose control of his bladder and bowel, soiling his or her clothing. Seizures caused by high fever usually last about 20 seconds.

If a seizure occurs, place the child on a soft surface (sofa, bed or rug) to protect the child from injury during the seizure. Be sure to carefully monitor the child's airway during and after the seizure. Seizures are frightening for the child's parents, who need your reassurance. If they become too emotional, ask them to leave the room.

Treatment For Seizures

Your treatment for a seizure is to protect the patient from self-injury and, after the seizure is over, to ensure that the airway is open, that the patient is breathing adequately, and that secretions and blood in the mouth have been cleared. Remember the following:

  • Stay calm. You cannot stop a seizure once it has started.
  • Place the patient on the floor or bed to prevent injury.
  • Do not restrain the patient.
  • Clear the area of hard, sharp or hot objects to protect the patient from injury.
  • Do not force anything between the teeth.
  • Do not be concerned if the patient stops breathing temporarily during the seizure.
  • After the seizure, turn the patient on his or her side and make sure breathing is not obstructed.
  • Provide supplemental oxygen after the seizure if it is available and if you are trained to use it.
  • Arrange prompt transport to an appropriate medical facility.

Garry Briese is the executive director of the International Association of Fire Chiefs (IAFC) and, along with David Schottke, co-author of the new edition of First Responder: Your First Response In Emergency Care, available from Jones & Bartlett Publishers. The book is produced by the American Academy of Orthopaedic Surgeons and the National Safety Council.