Drill of the Month
Developed by Gloria Bizjak
Altered Mental Status:
Assessing and Managing
Seizure Patients
Altered Mental Status: Assessing
and Managing Seizure Patients
Student Performance Objective:
Given information, resources, and opportunity for
discussion and practice, EMTs will be able to:
• List causes, types, and signs and symptoms of
seizures,
• Describe patient care procedures, and
• Demonstrate patient assessment and care.
EMTs will follow acceptable Maryland medical
practice and Maryland Medical Protocols for
Emergency Medical Providers.
Drill of the Month
2
Altered Mental Status: Assessing
and Managing Seizure Patients
Overview
 Causes of Seizures
 Types of Seizures and Their Signs and
Symptoms
 Patient Care Procedures
Drill of the Month
3
Causes of Seizures

By age group
– 6 months to 3 years
 Common: high fever (febrile seizures)
 Metabolic abnormalities
– High/low sugar or sodium levels
– Low calcium or magnesium levels
– Vitamin B6 deficiency
Once the abnormality is resolved the seizure will not
cease. Reoccurrence is likely from a birth injury/defect,
hereditary metabolic abnormality, or brain disorder
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4
Causes of Seizures

By age group
– Age 2 to 14 years
 Often the cause is unknown
 May be the result of measles, mumps, other
childhood diseases
Drill of the Month
5
Causes of Seizures

By age group
– After age 25
 Head injury (trauma)
 Stroke
 Tumor
 Alcohol withdrawal
– Seizure and altered mental state are two signs of
delirium tremens, a sign of alcohol withdrawal
– May result in death (35% if untreated; 5% if recognized
and treated early
– For about half the people in this age group,
the cause is unknown
Drill of the Month
6
Causes of Seizures

For any age group
– Idiopathic
 Occurring spontaneously with no identifiable cause
(common in children)
– Conditions that irritate the brain
 Injury
 Certain prescription or recreational drugs and drug
withdrawal
 Sleep deprivation
 High fever
– Heat stroke
– Infection
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7
Causes of Seizures

For any age group
– Conditions that deprive the brain of oxygen or
fuel
 Provoked seizure, usually non-epileptic; however
these conditions can cause seizure in epileptic
patients: History is important
– Low level of oxygen
 Abnormal heart rhythm
 Carbon monoxide poisoning
 Near drowning
 Stroke
Drill of the Month
8
Causes of Seizures

For any age group
– Conditions that deprive the brain of oxygen or
fuel
 Provoked seizure, usually non-epileptic; however
these conditions can cause seizure in epileptic
patients: History is important
– Metabolic disorders
 High/low level of sugar or sodium
 Low level of calcium or magnesium
 Kidney or liver failure
Drill of the Month
9
Causes of Seizures

For any age group
– Structural damage to the brain
 Noncancerous or cancerous tumor
 Head trauma and intracranial bleeding
 Stroke
– Exposure to toxins
 Lead
 Strychnine
Drill of the Month
10
Causes of Seizures

For any age group
– Fluid accumulation in the brain from
eclampsia
 Signs and symptoms of seizure
 Altered mental status
 Headache
 Visual disturbances
 Abdominal pain
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Causes of Seizures

For any age group
– Rare causes or triggers (reflex epilepsy)
 Repetitive sounds
 Flashing lights
 Video games
 Touching certain body parts
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Types of Seizures

Two categories
– Partial
– Generalized
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Types of Seizures

Partial
– Begin in a focal (limited or focused) part of
the brain
– Two categories
 Simple partial seizure
 Complex partial seizure
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Types of Seizures

Simple partial seizure (Also called motor, sensory
or Jacksonian seizures
– “Jacksonian” named for John Hughlings Jackson who
studied speech defects in brain disorders
– Signs/symptoms
 Tingling starts with fingers and moves proximally (epileptic
march)
 Twitching of muscles or extremities
 Head turning
 Visual changes
 Dizziness
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Types of Seizures

Simple partial seizure
– Signs/symptoms
 Aura
– Sensation of smelling odors, seeing lights or colors,
feeling of butterflies in the stomach
– First aid
 Do not restrain
 Remove items to avoid patient injury and guide
away from danger
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Types of Seizures

Complex partial seizure (Also called
psychomotor or temporal lobe seizures)
– Often preceded by an aura
– Signs and symptoms
 Confusion and no memory of the episode
 Abnormal behavior, possibly not noticed by others
 Staring, sense of déjà vu, visual hallucinations
 Aimless moving, fidgeting, repetitive motion
 Smacking, chewing lips
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Types of Seizures

Complex partial seizure
– Signs and symptoms
 Smelling unpleasant odors
 Struggling if restrained
 Altered mental state (loss of consciousness)
– First aid
 Do not restrain
 Remove items to avoid patient injury and guide
away from danger
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Types of Seizures

Generalized seizures
– Involve larger areas of the brain
– Affect both sides at the same time (compare
to partial seizure affecting one focused part
– Include four types
 Tonic-clonic
 Myoclonic
 Absence or petit mal
 Atonic
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Types of Seizures

Generalized seizures
– Tonic-clonic (grand mal seizure)
 Tonic refers to muscle tone or rigidity
 Clonic refers to spasm
 Signs and symptoms
–
–
–
–
–
May or may not experience an aura
Will often cry out before falling to the floor
Will become unconscious (altered mental state)
Will have major motor activity—thrashing of entire body
Will seize from 1 to 5 or up to 20 minutes
Drill of the Month
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Types of Seizures

Generalized seizures
– Tonic-clonic (grand mal seizure)
 Three distinct phases: Tonic (1)
– Body becomes rigid for about 30 seconds
– Patient may stop breathing but will resume
spontaneously
– Patient will rarely bite the tongue
– Patient may lose bowel and bladder control
Drill of the Month
21
Types of Seizures

Generalized seizures
– Tonic-clonic (grand mal seizure)
 Three distinct phases: Clonic (2)
– The body begins to jerk violently for 1 to 2 minutes and
up to 5 minutes
– May have froth at mouth and drool
– Face and lips may show cyanosis from breathing
cessation
Drill of the Month
22
Types of Seizures

Generalized seizures
– Tonic-clonic (grand mal seizure)
 Three distinct phases: Postictal (3) Post—after
the seizure; -tictal— “blow” or “stroke”
– May regain consciousness immediately but may be
confused; or may remain unconscious for several hours
– May feel sleepy, weak
– May have a headache
Drill of the Month
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Types of Seizures

Generalized seizures
– Myoclonic (myo—muscle; -clonic—spasm)
 Occur in children in their first five years
– Show brief jerking movement originating from CNS
– Seizures involve both sides of body; may be subtle,
barely noticeable or very dramatic, obvious
– Appear as clumsiness or sudden unexplained jerk (as
what happens during sleep to a foot or leg)
 First aid: none required; refer to Protocols
– After first significant event, medical evaluation is needed
Drill of the Month
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Types of Seizures

Generalized seizures
– Absence or petit mal
 Brief, 1 to 10 seconds; no warning or aftereffect
 Temporary lapse of awareness, concentration; sometimes
with staring
 No major motor activity—seizure goes unnoticed
 Start between ages 4 and 12, rarely begin after 20 and cease
in adulthood but may develop tonic-clonic seizures
 50 – 100 attacks a day interfering with thought activity and
learning
– First aid: none required; refer to Protocols
 Child should have medical evaluation
Drill of the Month
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Types of Seizures

Generalized seizures
– Atonic (also called “drop attacks,” astatic, or
akinetic seizures; a—”no” meaning no muscle
tone or rigidity, no muscle tension, flaccid)
 Sudden head drop, loss of posture, collapse
 Abrupt, without warning
 Falls with force (drops), injures head and face
(patients may wear head gear)
– First aid: None required except to treat
injuries; refer to Protocols
 Should receive medical evaluation
Drill of the Month
26
Patient Care Procedures

Demonstrate care based on Protocols
– Initiate general patient care
 Arrival and size-up
 Patient approach
 Initial assessment
–
–
–
–
Mental status
A,B,C,D,E
Clinical priority (1,2,3,4)
Disposition (mode, status)
Drill of the Month
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Patient Care Procedures

Demonstrate care based on Protocols
– Initiate general patient care
 History and physical exam/assessment
– What was the patient doing/how was the patient feeling
before the seizure?
– What did the seizure look like?
– How long did the seizure last?
– Did the patient lose bowel or bladder control?
– How did the patient respond after the seizure (awake,
sleep, able to answer questions)?
– What injuries did the patient sustain?
Drill of the Month
28
Patient Care Procedures

Demonstrate care based on Protocols
– Treatment
 Presentation
– Seizures and a neuromuscular response to an underlying
cause
 Epilepsy
 Hypoxia
 Hypoglycemia
 Hypoperfusion
 Head injury
 CVA
 Alcohol or drug abuse
Drill of the Month
29
Patient Care Procedures

Demonstrate care based on Protocols
– Treatment
 Presentation
– Consider recent history
 Illness
 Infection
 Fever
 Stiff neck
Drill of the Month
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Patient Care Procedures

Demonstrate care based on Protocols
– Treatment: Care for adult and pediatric
patients
 If patient is still seizing
–
–
–
–
–
–
Position on side (no spinal injury) for oral drainage
Do not force anything into mouth
Do not restrain
Loosen restrictive clothing
Protect from injury
Consider cause of seizure
Drill of the Month
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Patient Care Procedures

Demonstrate care based on Protocols
– Treatment: Care for adult and pediatric
patients
 After seizure stops
– Identify and treat injuries
– Suction airway if necessary
– If cyanotic, provide oxygen (12-15 lpm NRB or 2-6 lpm
nasal cannula—adults and peds)
– If diabetic, place glucose paste (10-15 grams) between
gum and cheek (in small doses for peds)
– Use AVPU scale to assess mental status
– Monitor vital signs and respirations
– Encourage transport
Drill of the Month
32
Altered Mental Status: Assessing
and Managing Seizure Patients
Student Performance Objective:
Given information, resources, and opportunity for
discussion and practice, EMTs will be able to:
• List causes, types, and signs and symptoms of
seizures,
• Describe patient care procedures, and
• Demonstrate patient assessment and care.
EMTs will follow acceptable Maryland medical
practice and Maryland Medical Protocols for
Emergency Medical Providers.
Drill of the Month
33
Altered Mental Status: Assessing
and Managing Seizure Patients
Review:
 Causes of Seizures
– List causes by age group: 6 mos.-3 yrs., 2-14, after 25
– List 7 causes for any age group

Types of Seizures and Their Signs and Symptoms
– Name two types of partial seizures; list signs and symptoms
– Name four types of general seizures; list signs and symptoms

Patient Care Procedures
– List the skill steps demonstrated during practice in caring for
seizure patients
Drill of the Month
34