2-21 ADULT SEIZURE

EMR - Emergency Medical Responder

1. Begin initial medical care.
2. If still seizing, protect patient from injury
   1. Do not restrain the patient
   2. Document closely type of seizure activity and eye deviation
3. If postictal:
   1. Maintain airway open by placing a nasopharyngeal airway
   2. Avoid placing anything in the patient’s mouth
   3. Place in recovery position if no chance of spinal injury
   4. Administer supplemental oxygen via any manner tolerated by the patient. Often, postictal patients are combative and only tolerate blow-by oxygen.
4. Identify pregnancy or recent (within 2 weeks) delivery for eclampsia, notify incoming ambulance ASAP.
5. Be aware of injuries the patient may receive from a seizure, such as tongue lacerations, shoulder dislocations and other bruises and lacerations
6. Initiate ALS Intercept if patient is still seizing or has had multiple seizures.

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Isolated seizures need no specific treatment other than provision of airway care with supplemental oxygen during postictal phase. If seizures occur repeatedly, or a single seizure lasts longer than ten minutes, initiate ALS response.
2. Perform Glucometry and follow hypoglycemia protocol if indicated.
3. Consider placing the patient on a cardiac monitor if trained to do so.  
4. If no airway compromise and LOC improving, consult Medical Control regarding ALS intercept and begin transport

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Initiate transport and establish IV en route to hospital.
2. Perform appropriate airway management based on patient condition.
3. If seizures occur repeatedly, or a single seizure lasts longer than ten minutes, initiate ALS intercept.

Intermediate - Perform/Confirm All Above Interventions

1. Consider Intraosseous if unable to obtain IV access.
2. If seizure persists consult Medical Control for further orders

Paramedic - Perform/Confirm All Above Interventions

1. Administer midazolam (Versed) 2 mg slow IV/IO push for repeated seizures or active seizures lasting greater than 1 minute.
2. If IV access is not available and the patient continues to seize, midazolam (Versed) 2 mg may be given IM, I/O, or IN.
3. If patient is in third trimester of pregnancy and suspected Eclampsia consult Medical Control for consideration of administration of magnesium sulfate infusion of 2 gm over 15 min. If seizures persist, consult Medical Control for orders to repeat up to 6 gm total