Now, let’s talk about the first topic
of managing a generalized seizure.
Now, one thing I want you to
know is that seizures can vary
on how serious they can be.
Sometimes you may see a small convulsion
or a seizure from a patient and
sometimes they can be very violent.
For the first thing to remember to know
is protect your patient from injury.
Not only that, an airway is also
a top priority when we are talking
about protecting our patients.
Now, the reason why this is the case,
is because sometimes with really violent
seizures, a patient could choke on their
own secretions and they can aspirate.
So, protecting them from injury
and also protecting the airway
is the utmost importance.
Now, for your patient who is in
bed when they have a seizure,
try to put up side rails.
The reason why we want to do this is,
we want to protect our patient because
we don’t want them falling out of bed.
Now, it’s really important to note,
we do not want to physically hold
down a patient or restrain them
when they are having a seizure.
So, just know this, they can move
around the bed but protect them also
from those side rails from injury.
Now, if your patient is on the floor
when they have a seizure, make sure
you put something soft underneath
their head, because the consistent
seizure can have them keep hitting
their head on the hard surface of
the floor, this can cause trauma.
Now, if you have a blanket, a towel, a
soft pillow, anything underneath their
head is really important to protect that.
Now, notice, call for help
early and know the time.
So, you want to make sure you get help
in their way with you to protect the
patient, also we want to know the time.
This is realty important for the
provider because we need to know
how long that seizure lasts.
Now, if possible, position
the patient to their side.
Now, we need to really note, anytime
someone has a seizure it’s really
important we don’t want to physically
retain or hold down the patient,
this could cause further injury.
Now, however, if it’s safe to do so,
turn the patient on their side, this
will help reduce the risk of aspiration.
Now, one other important note is do
not leave the patient, so, during
a seizure many things can happen, a
patient’s heart can stop, they can stop
breathing, so, it’s really important
to say with the patient the whole time.
Now, if it’s safe to do so, remove
the patient’s eyeglasses, so, that
they make sure they don’t injure their
face or any restrictive clothing.
Sometimes a patient’s gown can get
twisted around their neck, and we want
to make sure we remove this if possible.
So, shortly after a seizure, we need
to manage care for that patient.
So, first of all, administer
oxygen as needed after the seizure.
We need to support their oxygen status.
Now, next, this where the IV catheter
comes in, we want to set this up and
make sure the patient has IV access.
So, this is really important because
if a patient has a seizure, what we
don’t want to happen is the patient
to have multiple seizures after that.
Therefore, we’ll have IV catheter in for
emergency drugs and something like Ativan
for example to prevent further seizures.
This is important about
suctioning the patient’s airway
and keeping that airway open.
Now, a really important point
is notice we are talking about
suctioning after the seizure.
One thing I want you to note,
during an active seizure, please
never pit something in a patient’s
mouth during an active seizure.
That’s really dangerous for
the patient and could be
potentially dangerous for you.
So, notice after the seizure, we are going
to suction the patient out, try to clear
those secretions and prevent aspiration.
Now, all your monitoring after
seizure is really important, to
watch their hemodynamic status.
Now, this can change before,
during and even after a seizure.
So, please make sure you keep
an eye on your patient and
provide frequent monitoring.
So, now, I want to talk to you about
a period in seizure management called
postictal management of a seizure.
Now, when we are talking about postictal
state, this is the time when the
seizure subsides and then the patients
are returning back to baseline.
So, at this point the patient is a little
more cognitive than they were earlier.
Also, I want to talk to you about
postictal delirium, now, this can
typically last for hours but it really
can even continue up to 1 -2 days.
Now, one thing to notice is after a
seizure, your body is under lots and
lots of stress and there’s a lot of
fatigue, there’s a lot of cognitive drain,
there’s a lot of shock to your system.
So, this may take quite a while for
a patient to recover and this is
going to vary from case to case.
Now, in the postictal stress
we want to assess for injury.
Now, many things can happen during a
seizure, so, we want to take a thorough
head to toe assessment of our patient.
Next, we want to make sure we
access their cognitive state.
It is really mentally draining after
you have a seizure and physically.
So, we want to assess this
thoroughly in our patients.
Now, if you haven’t done so, make
sure you notify the provider.
This is really important because
for example, if a patient has
maybe epilepsy, a seizure disorder.
This is bound to be expected
that they have a seizure, right?
So, if that’s the case we need to take
a thorough look at their medication.
However, sometimes patients have seizures
because maybe an abnormal electrolyte
imbalance for example, and this seizure
could be brand new to the patient.
So, it’s really important that you notify
the provider and let them know how long
the seizure lasts and what kind of seizure
and the characteristics of that seizure.
Now, in that postictal state, because
the patient’s cognition and physically
they were drained, we need to assess
for urinary and bowel incontinence.
We need to make sure of the
patient’s personal hygiene is
taken care of and their comfort.
We also want to continue to monitor
those vital signs and make sure we
keep an eye on that hemodynamic status.
Now, if the patient is awake and they are
able to converse and talk, talk to your
patient about the events that started
for them before their seizure onset.
Now, what I’m talking about by this
is some people can start feeling what
they call maybe an oh, that happened
or they just had that feeling they knew
that the seizure was going to come.
Now, this is different from every single
patient, and if they are dealing with
a seizure disorder, they typically know
what this feels like before seizure onset.
So, make sure you talk to your
patient to gather that data.
Now, after the seizure we want
to continue to make sure those
precautions are in place.
So, if you remember this is going to
be suctioning, oxygen, watching their
vital signs, protecting that airway.
And one thing to keep a note, is if
you were able to, typically there are
maybe parting or some sort of protective
cloth over those side rails, that way
if a patient has a seizure, it will
also help them protect from injury.
Now, during this time, we should be
done making sure the patient’s safe,
we can remove our gloves, perform our
hand hygiene before exiting the room
and document the event thoroughly.