12. Convulsions/Seizures - ABCD

Question 1

Determining AGONAL BREATHING

Question 2

Continuous Seizure

Answer 2

A seizure in an unconscious patient that is still in progress at the end of the interrogation and after a physical verification by caller (EMD must stay on line to check)

Question 3

Multiple Seizure

Answer 3

The occurrence of more than one seizure in a patient who remains unconscious or not alert between episodes

Question 4

Focal Seizure

Answer 4

Localized twitching of a part of the body, such as the hand, arm, leg, or face, in a conscious patient

Question 5

Absence Seizure

Answer 5

Brief “staring spell” in a conscious patient caused by abnormal electrical activity in the brain. Absence seizures usually last less than 10 seconds, but some last slightly longer and may also include abnormal muscle activity, including fluttering eyelids, smacking lips, chewing motions, and/or hand gestures. While technically a generalized seizure, they are clinically handled much more like a FOCAL seizure

Question 6

Atypical Seizure

Answer 6

A seizure that is mentioned as different from (or not typical of) the patient’s previous seizures

Question 7

Problem Suffix

Answer 7

E: Epileptic or Previous Seizure Diagnosis

Question 8

Recurrent Seizure

Answer 8

Epileptics may have more than one seizure in a day. These are considered recurrent seizures if the patient is able to regain consciousness between episodes

Question 9

Seizure

Answer 9

An abnormal firing of brain cells, usually resulting in jerking movements. Also known as convulsions, epilepsy, or fits.

Question 10

Febrile Seizures

Answer 10

Occur in 3-5% of all children between 6 months and 5 years of age as result of fever. They are not prehospital emergencies but must always be evaluated by a physician to rule out rare but serious brain infections. The risk of death from a febrile seizure itself is virtually 0.

Question 11

Rule 1

Answer 11

Use of the AGONAL BREATHING Detector is mandatory after the jerking/twitching has stopped for all generalized (non-focal) seizure patients who are breathing or whose breathing is questionable

Question 12

Rule 2

Answer 12

AGONAL/INEFFECTIVE/UNCERTAIN BREATHING after a seizure has stopped (after KQ) should be considered a cardiac arrest until proven otherwise (PAIs should be instituted immediately)

Question 13

Rule 3

Answer 13

When effective breathing cannot be physically verified by the caller, a seizure in a person ≥ 35 is coded DELTA due to an increased probability of cardiac arrest

Question 14

Rule 4

Answer 14

When the complaint description is seizure, go to Protocol 12 regardless of consciousness and breathing status

Question 15

Rule 5

Answer 15

Do not attempt to reduce fever in febrile seizure patients

Question 16

Axiom 1

Answer 16

Seizure-like activity can be an initial symptom of cardiac arrest. Therefore careful breathing evaluation and monitoring is critical after a seizure has stopped

Question 17

Axiom 2

Answer 17

A seizure patient with an unknown history of seizures has most likely had seizures before

Question 18

Axiom 3

Answer 18

A history of childhood febrile seizures does not constitute a diagnosed history of seizures in an adult patient

Question 19

Axiom 4

Answer 19

The mention of an ATYPICAL seizure is associated with poor patient outcomes and may indicate a serious underlying cause unrelated to a seizure disorder

Question 20

Axiom 5

Answer 20

Tonic-clonic (Grand mal) seizures generally last about 60 sec

Question 21

Axiom 6

Answer 21

Reducing fever in child after febrile seizure is of little value as the precipitating factor is believed to be the rapid rise of temperature. The fever itself is of no harm and may even help the body battle the infecting microbes.

Question 22

Axiom 7

Answer 22

Some patients experience a premonition or sensation (aura) prior to having a seizure. An aura may involve strange sights, sounds, smells, or tastes. These patients may call for an ambulance before actually having a seizure.

Question 23

Causes of seizures

Answer 23

• Cardiac arrest (anoxia-lack of oxygen)
• Diabetes
• Drug (cocaine, amphetamine)
• Eclampsia (due to pregnancy)
• Epilepsy (unknown cause)
• Fever (in children)
• Hypoxia (inadequate oxygen)
• Meningitis (infection around brain)
  *Trauma
• Tumor