Seizures are a group of neurological disorders caused by excessive discharge of cerebral neurons. They may lead to focal (motor, sensory (somatic, visual, auditory, olfactory); psychomotor (automatisms, psychical); or generalized (myoclonic, absence, and tonic-clonic or grand mal (Table 12) seizures. The cause may be genetic; or head trauma, hypoxia, infection (fever) pregnancy, drug or alcohol overdose or withdrawal, sensory input (e.g., sound, light, touch, and smell), hypoglycemia, circulatory disturbances, degenerative disorders, and tumors.
Table 12. Tonic-clinic (grand mal) Seizure.
Prevention:
Identify at-risk patient
Eliminate known causative or precipitating factors (if possible)
Confirm compliance with anticonvulsant chemotherapy
Reduce anxiety
Ensure profound local anesthesia
Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity
Signs and symptoms:
Aura phase
Visual and auditory disturbances
Dizziness
Sudden loss of consciousness
Initial convulsions explosively force air out of the lungs, resulting in the epileptic “cry”
Generalized motor tonic-clonic seizures follow this eerie, birdlike scream
The tonic component is characterized by opisthotonos, the person is forced into an arched position when the violent spasm of all body musculature pulls his back muscles
Arching of the back creates a convexity in the ventral body region
The clonic component is characterized by alternating contraction and relaxation of all muscles
Tongue-biting
Increased salivation
Incontinence
Hyperventilation
Postictal depression of motor and sensory function
Fatigue, mental confusion, and respiratory depression
Emergency response:
Place patient in a supine position
Protect patient from injury
Guide the extremities during seizure, but do not restrain
After the seizure is complete
Suction oral cavity if needed
Position patient on his/her side (recovery position)
Administer oxygen
4 to 6 L/minute by nasal cannula
Monitor vital signs
If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest
Notify EMS
Immediate CPR and defibrillation congruent with current recommendations
Nota bene:
Signs of recovery: patient regains consciousness, respiration returns to normal
Signs of deterioration: unconsciousness persists, respiratory depression progressing to respiratory arrest
