MASTER TEACHING NOTES
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Detailed Lesson Plan
Chapter 19
Seizures and Syncope
75–90 minutes
Case Study Discussion
Teaching Tips
Discussion Questions
Class Activities
Media Links
Knowledge Application
Critical Thinking Discussion
Chapter 19 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
I.
5
10
Master Teaching Notes
Introduction
Case Study Discussion
A. During this lesson, students will learn special considerations of assessment
and emergency care for a patient experiencing a seizure or syncope.
B. Case Study
1. Present The Dispatch and Upon Arrival information from the chapter.
2. Discuss with students how they would proceed.
II. Seizure—Pathophysiology of Seizures
A. A seizure is a sudden and temporary alteration in brain function caused by
massive, continuing electrical discharges in a group of nerve cells in the
brain.
B. Seizures produce changes in mental activity and behavior ranging from brief
trancelike periods of inattention to unresponsiveness and convulsions.
C. Seizures are a sign of an underlying defect, injury, or disease.
D. Epilepsy is a chronic brain disorder characterized by recurrent seizures.
E. Seizures of various types many be mistaken for other conditions.
F. Seizures are categorized as either primary or secondary.
1. Primary seizures in adults are usually due to a genetic or unknown
cause.
a. Generalized seizures involve both hemispheres of the brain and the
reticular activating system, often resulting in convulsions and loss of
consciousness.
b. Partial seizures are typically related to abnormal activity in just one
cerebral hemisphere and are either simple (remain conscious) or
complex (altered mental status or unreponsiveness).
2. Secondary or reactive seizures do not result from a genetic cause but
occur as the result of an insult to the body (e.g., fever, hypoxia, drug
intoxication, eclampsia).
a. This type of seizure is often generalized in nature.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 19
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Given the length of the seizure, what is
your level of concern?
 What are some possible causes of
seizures that you should consider?
Video Clip
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access a
video on seizures and epilepsy.
Discussion Question
Besides epilepsy, what are some causes of
seizures?
Weblink
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access a
web resource on status epilepticus.
PAGE 1
Chapter 19 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
b. This type of seizure is extremely dangerous and can result in death.
G. A patient who suffers generalized motor seizures that last more than five
minutes or seizures that occur consecutively without a period of
responsiveness between them is considered to be in status epilepticus.
20
III. Seizure—Types of Seizures
A. Generalized tonic-clonic (grand mal) seizure
1. Begins with abnormal electrical activity low in the cerebral cortex that
spreads upward, affecting both cerebral hemispheres, and downward,
affecting the reticular activating system
2. Five stages
a. Aura—Warning
b. Loss of consciousness
c. Tonic phase—Muscle rigidity
d. Hypertonic phase—Extreme muscle rigidity and hyperextension
e. Clonic phase—Convulsion
f. Postictal state—Recovery
3. Emergency medical care
a. If patient is in postictal state, provide reassurance and conduct
assessment.
b. If patient refuses transport, follow local protocol.
c. If patient is in status epilepticus, establish and maintain an airway,
ventilation, oxygenation, and circulation.
B. Simple partial seizure
1. Also known as focal motor seizure or Jacksonian motor seizure
2. Involves only one cerebral hemisphere
3. Produces jerky muscle activity in one area of the body but may spread to
another area or progress to a generalized tonic-clonic seizure
4. Patient remains awake and aware.
5. Document where seizure activity began and how it progressed.
6. Emergency medical care—Contact medical direction or follow local
protocol if patient refuses care.
C. Complex partial seizure
1. Also known as psychomotor or temporal lobe seizure
2. Involves only one cerebral hemisphere
3. Patient will remain awake but will be unaware of his surroundings.
4. Lasts one to two minutes and may include blank stare followed by
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 19
Critical Thinking Discussion
What are the consequences of prolonged
seizure activity?
Video Clips
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access
videos on absence seizures, partial
seizures, and tonic-clonic seizures.
PAGE 2
Chapter 19 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
random activities (e.g., chewing, lip smacking, rolling fingers)
5. Post-seizure confusion may last longer than a few minutes.
6. Emergency medical care—Stay with the person until he is completely
aware of his surroundings, and follow local protocol is he refuses
transport.
D. Absence (petit mal) seizure
1. Mostly common in children
2. Characterized by blank stare, beginning and ending abruptly, and lasting
only a few seconds
3. No emergency care is necessary; however, if it is a first-time
observation, recommend medical evaluation.
E. Febrile seizure
1. Caused by high fever, often in children six months to six years of age
2. Most often do not need emergency care
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IV. Seizure—Assessment-Based Approach to Seizure Activity
A. Scene size-up
1. Look for mechanism of injury or prescription medications that may
indicate history.
2. Always begin with the assumption that the seizure patient needs
emergency care.
3. Follow proper patient refusal procedure if necessary.
4. If patient is still seizing upon arrival, be sure patient receives proper care
(e.g., guide movements rather than restrain)
B. Primary assessment
1. Form a general impression of the patient.
2. For the patient in a postictal state who is talking without distress,
continue with the secondary assessment and realize the patient may not
require emergency care.
3. For the patient who is not responsive, actively seizing, or in status
epilepticus
a. Open the airway with a jaw-thrust or head-tilt, chin-lift maneuver.
b. Suction and insert nasopharyngeal airway as necessary.
c. Begin positive pressure ventilation if the patient is severely cyanotic,
the seizure has lasted for greater than five minutes, or the breathing
does not immediately become adequate following the episode.
d. Note the skin temperature and color.
e. Ensure the presence of a pulse if the patient is unresponsive.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 19
Teaching Tip
Emphasize the need to balance a patient’s
rights and autonomy with concern for his
medical condition. Try to gain the
cooperation of the patient who does not
wish to be transported.
Class Activity
Provide students with ample opportunity to
practice assessment and management of
patients with seizures.
Discussion Question
What causes hypoxia in the patient having
a tonic-clonic seizure?
PAGE 3
Chapter 19 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
f. Initiate CPR and apply the AED if the patient is pulseless.
g. Determine if patient is transport priority (e.g., evidence of head
trauma, pregnant patient).
C. Secondary assessment
1. If patient is transport priority, conduct secondary assessment en route to
the hospital.
2. Assess the head for injury and extremities for paralysis or injury.
3. Assess and record the baseline vital signs.
4. Apply a pulse oximeter.
5. Assess the blood glucose level if protocol permits.
6. Gather a history from the responsive patient, relatives, and bystanders
(e.g., when the seizure started; how long it lasted; description of activity
during seizure).
7. Be aware that seizures can be mistaken for other disorders.
8. Signs and symptoms of a seizure
b. Convulsions
c. Rigid muscular contraction or muscle spasm
d. Bitten tongue
e. Excessive saliva
f. Urinary or bowel incontinence
g. Chewing movement, smacking lips, wringing hands or some other
repetitive activity
h. Localized twitching of muscles
i. Visual hallucinations
j. Olfactory hallucination
D. Emergency medical care
1. Position the patient.
2. Maintain a patent airway.
3. Suction.
4. Assist ventilation if necessary.
5. Prevent injury to the patient.
6. Maintain oxygen therapy.
7. Transport.
E. Reassessment
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 19
Discussion Questions
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What are some indications that a patient
having, or who has had, a seizure, is a
high priority for transport?
 What should you be looking for in the
secondary assessment of a patient who
has had a seizure?
Knowledge Application
Given several scenarios of patients who
have had, or who are having, a seizure,
students should be able to identify the
appropriate priority for transport.
PAGE 4
Chapter 19 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
10
15
Content Outline
V. Seizure—Summary: Assessment and Care for Seizures
A. Review assessment findings and emergency care for seizures.
B. See Figures 19-5 and 19-6.
VI. Syncope
A. Syncope, or fainting, is a sudden and temporary loss of consciousness.
B. It occurs when, for some reason, there is a temporary lack of blood flow to
the brain, and the brain is deprived of oxygen for a brief period.
C. Common cause is the overwhelming influence of the parasympathetic
nervous system that causes blood vessels to dilate throughout the body.
D. Type of faint in which patient is in a standing or seated position, allowing
blood to pool in the lower extremities, is called a vasovagal faint.
E. Difference between a seizure and a syncope
1. Episode usually begins in a standing position.
2. Patient remembers feeling faint or lightheaded.
3. Patient becomes responsive almost immediately after becoming supine.
4. Skin is usually pale and moist.
F. Place the patient in a supine position and conduct primary and secondary
assessments. (Be alert to possible spinal cord injury from fall).
G. Patient may refuse transport; follow local protocol in this situation.
H. Remember that syncope could be a sign of a serious illness or injury
(especially in older patients).
VII.
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Master Teaching Notes
Follow-Up
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access a
web resource on syncope.
Discussion Questions
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What are some causes of syncope?
What signs and symptoms might be
reported just prior to a syncopal
episode?
Critical Thinking Discussion
What kinds of medications might make a
patient prone to syncope?
Class Activity
Provide students with opportunities to
practice assessment and management of
patients with a complaint of syncope.
Case Study Follow-Up Discussion
A. Answer student questions.
B. Case Study Follow-Up
1. Review the case study from the beginning of the chapter.
2. Remind students of some of the answers that were given to the
discussion questions.
3. Ask students if they would respond the same way after discussing the
chapter material. Follow up with questions to determine why students
would or would not change their answers.
C. Follow-Up Assignments
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
Weblink
DETAILED LESSON PLAN 19
Would you feel comfortable with Carmen’s
refusal of treatment? Why or why not?
Class Activity
Alternatively, assign each question to a
group of students and give them several
minutes to generate answers to present to
the rest of the class for discussion.
PAGE 5
Chapter 19 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
1. Review Chapter 19 Summary.
2. Complete Chapter 19 In Review questions.
3. Complete Chapter 19 Critical Thinking.
D. Assessments
1. Handouts
2. Chapter 19 quiz
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 19
Teaching Tips

Answers to In Review and Critical
Thinking questions are in the appendix
to the Instructor’s Wraparound Edition.
Advise students to review the questions
again as they study the chapter.
 The Instructor’s Resource Package
contains handouts that assess student
learning and reinforce important
information in each chapter. This can be
found under mykit at
www.bradybooks.com.
PAGE 6