From the Guidelines
To confirm a seizure in a pre-hospital setting, look for characteristic signs including rhythmic jerking movements, loss of consciousness, tongue biting, urinary incontinence, and a postictal state (confusion, drowsiness, headache) following the event. When evaluating a patient with a suspected seizure, it is crucial to prioritize their safety and well-being, considering the potential impact on morbidity, mortality, and quality of life. According to the clinical policy for evaluating adult patients presenting to the emergency department with seizures 1, a diagnostic process is necessary to distinguish seizures from other conditions that may resemble convulsive seizures.
Key Considerations
- Ensure scene safety and protect the patient from injury by moving hazards away and placing them in a recovery position.
- Document the seizure's duration, any focal features (such as movement starting in one limb), eye deviation, and whether the patient had a warning (aura).
- Check vital signs including blood glucose levels, as hypoglycemia can trigger seizures, as noted in the evaluation of adult patients with seizures 1.
- Ask bystanders about the event's onset, duration, and whether the patient has a history of seizures or takes antiepileptic medications.
- Differentiate seizures from syncope, psychogenic non-epileptic seizures, and movement disorders by noting that true seizures typically involve a postictal period and may have tongue biting or incontinence.
Medical Emergency
Remember that status epilepticus (seizures lasting over 5 minutes or multiple seizures without recovery between them) is a medical emergency requiring immediate treatment with benzodiazepines, such as midazolam or diazepam, depending on protocols and available medications, as discussed in the context of seizure management 1. The American Heart Association/American Stroke Association guidelines 1 also emphasize the importance of prompt recognition and management of neurological emergencies, including seizures, although they primarily focus on stroke.
Prioritizing Patient Care
In the pre-hospital setting, prioritizing the patient's airway, breathing, and circulation (ABCs) is essential, followed by a focused examination to identify signs of seizure or other conditions, as outlined in stroke management guidelines 1. However, the primary concern in this context is the confirmation and management of a seizure, considering the potential for significant morbidity and mortality if not addressed promptly and effectively.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Confirming a Seizure in the Field Pre-Hospital
To confirm a seizure in the field pre-hospital, the following steps can be taken:
- Assess the patient's airway, breathing, and circulation (ABCs) and provide supportive care as needed 2
- Check the patient's blood glucose level, as hypoglycemia can cause seizures 3, 2
- Observe the patient for signs of seizure activity, such as convulsions, loss of consciousness, or altered mental status
- Take a careful history of the event, including the duration of the seizure and any potential causes 2
Treatment Options
Treatment options for seizures in the pre-hospital setting include:
- Benzodiazepines, such as intramuscular midazolam or intranasal midazolam, which are effective and easy to administer in the field 4, 5, 6, 3
- Intravenous lorazepam, which is a commonly used treatment for status epilepticus 4, 5, 6
- Other medications, such as fosphenytoin, phenobarbital, valproate, and levetiracetam, which may be used in certain situations 4, 6
Protocols and Guidelines
Protocols and guidelines for the pre-hospital treatment of seizures vary widely across different emergency medical services (EMS) agencies 3
- A review of the evidence-based recommendations for the pre-hospital evaluation and treatment of adult and pediatric patients with a seizure found that protocols across EMS agencies in California varied widely 3
- The use of benzodiazepines, such as midazolam, is widely accepted as a first-line treatment for seizures in the pre-hospital setting 4, 5, 6, 3