Medical Emergencies

Seizure Emergencies

A seizure is caused by abnormal electrical activity in the brain. Seizures fall into two types: focal (partial) seizures and generalized seizures. The type of seizure will influence the casualty’s signs and symptoms.

Types of Seizures

There are two types of seizures: focal and generalized.

Focal seizures

Focal seizures occur when seizure activity is limited to one area of the brain. Casualties may or may not lose awareness during their seizure and can be seen exhibiting these signs:

  • Confusion
  • Repetitive gestures (e.g., picking at a button)
  • Wandering aimlessly in a specific area
  • Smacking their lips

Generalized seizures

When there is widespread seizure activity in the brain, it is called a generalized seizure. There are several different types of generalized seizures, but two of the most common are absence seizures and convulsive seizures.

Absence Seizures are common in children through to adolescence, though they sometimes persist into adulthood. They are often mistaken for daydreaming. Casualties may blink rapidly and smack their lips.

Convulsive Seizures are what most people think of in terms of a seizure. Someone experiencing a convulsive seizure will often tense up, lose consciousness, and fall. Their body will remain rigid for a short time. This is followed by convulsions – a rapid contraction and relaxation of the muscles in an uncoordinated fashion.

During a convulsive seizure, the casualty may turn blue, froth at the mouth, and grind their teeth.

The seizure may come on very quickly, and usually lasts only a few minutes. Once the seizure has ended, the muscles will relax, and the casualty will start to regain consciousness.

Common Causes of a Seizure

Epilepsy is a disorder of the nervous system and is characterized by seizures. Many people with seizure disorders like epilepsy take medication to control the condition. With epilepsy, the person may know that a seizure is about to occur because of a brief sensation they experience, called an aura. An aura, which is often felt just before a seizure, may be a hallucination in the form of a sound, a smell, or a feeling of movement in the body.

Other causes of seizures include:

  • Head or brain injury
  • Stroke
  • Brain infection
  • Drug poisoning
  • A high fever in infants and children

First Aid for a Seizure Emergency

Call 9-1-1 unless the casualty is known to you and has a history of seizures. Call when:

  • The seizure lasts for more than 4 to 5 minutes.
  • A second seizure follows the first without the casualty regaining consciousness.
  • There are any injuries because of the seizure.
  • The seizure takes place in water.

During a seizure, first aid is limited to protecting the casualty from additional injury. If there are hazards around the casualty, move them away. If possible, place a pillow, sweater, or other padding under their head.

Some people experience a seizure with little movement of the limbs. For these seizures, if possible, place the casualty on their side to help keep the airway open. If you cannot roll the casualty safely, allow the seizure to occur in the position you found them in.

Never attempt to place anything in the casualty’s mouth. While it is possible for the casualty to bite their tongue during the seizure, placing something to protect it (a spoon for example) increases the risk of damage to the teeth, and also places the first aider at risk of being bitten.

If the seizure occurs in water (e.g., a bathtub), first aiders should try to hold the casualty’s head above the water.

Postictal State

Following a seizure, a casualty may be confused, and not recall what happened. They may be aggressive or combative, or they may be scared. Take steps to protect yourself and others on the scene. The postictal state usually lasts for only a few minutes, after which the casualty will often become quite drowsy.

Post-Seizure Care

Once a seizure has ended, perform the following steps to care for the casualty until EMS arrives:

  1. Place the unconscious casualty into the recovery position and clear any fluids from their mouth or nose.
  2. Perform a secondary survey to see if the casualty was injured during the seizure; give first aid for any injuries.
  3. Give ongoing casualty care, monitoring breathing, keeping the casualty warm, and allowing them to rest.
  4. Do not give the casualty any liquids during or immediately after a seizure.