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Now we're going to talk about seizures in children. There's a lot of things that can cause a seizure. I mean we could list them out, and it is so varied. It's incredible. But the point of the matter is, what do we do with the patient who has a seizure, and when do we know when to call 911? Very rarely, we'll have an epileptic child who has a standing policy that they give to the educators where they're not supposed to call the ambulance, because they're a known epileptic. There's a way of treating that. But in most cases, and especially when you didn't know that the child was an epileptic or that there was a standing policy, we're simply going to go ahead and just treat them as if this was their very first seizure, no matter what the reason they had it. We're going to make sure that the scene is safe, our CPR shield is available in case they're in full cardiac arrest, and then we're going to go ahead and start treating the seizure patient. The first thing we want to make sure of is that there's nothing surrounding an actively seizing patient that could cause more harm, like sharp objects, chairs, pointed metal. In this case we're at a playground. Maybe they're too close to the monkey bars. And there's different kinds of seizures. There's the petit mal seizures, there's the grand mal seizures, there's the tonic and the clonic, or just the tonic. Tonic-clonic means they're kind of contracting and then letting go, and contracting and letting go. We saw a little bit of that where she was kind of bumping her head on the ground, but it wasn't real exaggerated. It was just kind of more of a moderate seizure. But if they're really tonic and then clonic and they're seizing hard, they could be causing more secondary injuries simply because nothing's protecting them during the seizure. In that case, if we had something soft that we could place under their head, we would do that-- rolled up coat, hoodie, towel, diaper. If we don't have anything else, our hands cupped underneath their head, just so that's something softer for them to comfort their head so they don't have a concussion. After the seizure has passed, that's when we go into our secondary assessment and make sure that we know what we're dealing with. Check for any major injuries or bleeding. Make sure that if there's anything that's kind of obstructing their airway we're aware of that. But more importantly than anything else, that we get this person into a recovery position that they can then go through their recovery time while the gravity works with them and not against them. In other words, we want gravity to kind of pull their saliva, or maybe they bit their tongue, and so the blood that they may be having in their mouth from the bitten tongue could then come out and to the side. They might also get sick and vomit. That too could then flow out of their mouth and not back into their airways. So as we're doing this, we've already checked the patient over. We know that there's no real serious other injuries other than the seizure that occurred. We activated EMS or called 911, because to us, this was this child's first seizure. We don't know anything else, and so we're going to call 911. And then as they come out of the seizure, here's how we put them into the recovery position. This position's going to allow for gravity to help keep fluids out of her airway and put her in a position of comfort while she's recovering from the seizure while we await EMS's arrival. So the first thing we're going to do here is we're going to bring the hand that's closest to us and bring it up over her head. Remember, we don't suspect any spinal cord injuries or anything like that, so we're not in any danger of moving limbs around, but here we're going to raise this up here. Now we're going to take the leg that's furthest away and bring it over and hook her ankles, so it keeps her whole body rolling as a unit. Now I'm going to grab her wrist and her hip while I reach under the head and neck as I draw the patient towards me. The rescuer always draws the patient towards themself so as to be able to control the roll. If I were to try to push her away, there's a risk that it would be really uncoordinated and that we risk rolling them all the way over onto their face, and we don't want that to happen. I also like to keep my eye on the expression and the face to see if there's any signs of pain or responsiveness, and so this is the method for rolling a patient. Now I'm going to grab down here on the knee and I'm going to bring the knee up to be able to be like a kickstand of sorts so she doesn't roll the rest of the way over. Now I grab her head, support it while I untuck my hand, and lay her head down on her arm. I roll her just a little bit more so that we have gravity now working with us, not against us, bring any blood, saliva, or vomit out of her mouth, which is very common secondary to seizures. Now some things to note here. We talked about blood in the mouth. That's usually because they bite their tongue, very common. They could also break off teeth. Years ago there was this understanding that we were trying to put these bite blocks in place to prevent that from happening. Not anymore. We don't put anything in the seizing patient's mouth at all. We don't try to put our fingers in there, we don't put any bite blocks, we don't put any pens or combs or brushes, nothing. We just keep the person's mouth as safe as we can and deal with it after the fact. Having them in this recovery position helps keep their airway open, but if this person were to actually have any problems, we would roll them back onto their back, and then we would actually begin our assessment and treat accordingly, if they stopped breathing, lost their pulse, or anything like that. Remember, it's important that if the patient is seizing, we're not trying to hold them down. We're not trying to stop them from convulsing. We're just trying to keep them safe while they are in that convulsion. Then after that passes and they're in the recovery phase, we then put them back in the recovery position and await EMS's arrival.
In this lesson, you'll learn how to treat a child or adult who goes into a seizure or has just come out of one, including when to call 911.
A person can have a seizure for too many reasons to mention. As you are concerned, why it happened isn't important. Being able to recognize it and treat it is the key.
For you to know if a seizure took place, ideally you or someone else saw the patient go into a tonic state that exhibited the following signs:
- Hands are gripped and pointed inward
- The patient is actively seizing
- The patient ends the seizure in the postictal state (relaxed recovery)
Pro Tip #1: Some seizure victims will be known epileptics and many of the people around them will probably know how to care for one and have been through it before. But if you're helping a person you don't know to be an epileptic, treat this event as the person's first seizure.
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.
However, if the victim is in the middle of a seizure, you'll want to start with the following:
- Call 911 and activate EMS. (Or better yet, ask a bystander to do it while you help the victim.)
- Protect the victim from any environmental hazards, like sharp objects.
Pro Tip #2: There are many different types of seizures, some of which can be more active than others and involve the victim violently contracting and releasing. It's also quite common for a seizure victim to hit his or head on the floor or ground while seizing.
Warning: Never try to hold down or prevent a seizing person from a having a seizure. All you can do for them is to keep them safe during the episode.
- Place something under the seizing victim's head like a coat or hoodie or even your hand.
- After the seizure has passed, begin a secondary assessment of the victim. Do you notice any major injuries or airway obstructions? Are there any other potentially life-threatening issues?
- Get the victim into a recovery position.
The Recovery Position
To help keep the victim's airway open and clear, put them into the following recovery position. You want gravity to work with you, as there could be saliva, blood (if the victim bit his or her tongue), or eventually vomit that may need to come out, rather than back into the victim's airway.
- Elevate the arm closest to you and bring it up over the victim's head before placing it on the ground.
- Bring the victim's furthest leg over their other leg so that their legs are crossed.
- Grab the wrist of the furthest arm and the hip together, while placing your other hand under the head and neck and roll the victim toward you and onto their side.
Pro Tip #3: Always roll the victim toward you, not away. You'll have better control over them and will be much less likely to accidentally roll them too far and onto their face. Plus, being able to see their face could be important for visual clues of how they're doing.
- Support the head while you place the victim's outstretched arm under their own head and with the chin pointing down, allowing gravity to help clear the airway.
- Bend the victim's top leg to a 90-degree angle at the knee, essentially creating a kickstand to help protect the victim from rolling over.
While waiting for EMS to arrive, continue to assess the victim for breathing and recovery signs, like talking. Any signs that the person is becoming more responsive are good signs.
Remember, if the victim begins showing signs of shock – cool, pale, sweaty skin and a rapid pulse – cover him or her with a sheet, coat, or blanket and keep them as warm and comfortable as possible while waiting for EMS to arrive.
A Few Common Questions About Seizures
What about putting something into the victim's mouth to keep them from biting or swallowing their tongue?
This practice is no longer recommended. DO NOT put anything into a seizing person's mouth. All you can do is keep them comfortable and safe during the ordeal.
What if the person stops breathing while in the recovery position?
If there any problems at all – the victim isn't breathing normally, loses a pulse, loses consciousness, etc. – roll them back onto their back and treat them accordingly.
If the person stops breathing but still has a pulse, perform rescue breathing. If the victim stops breathing and loses his or her pulse, begin full CPR.
Why do seizure victims seem confused after a seizure?
A person who has just experienced a seizure – essentially an electrical storm in the brain – will be low on oxygen. As a result, they may be confused or combative and this will likely last a few minutes.