Spinal precautions for seizure patient

[nymedic9999]

Quick question. Say you had a patient who suffered a ground level fall secondary to a seizure. Patient presents as atraumatic and is seizing on the floor upon arrival. Would you take spinal precautions due to the fall and the fact that the patients is still seizing?

 

[Qulevrius]

Not sure how you can actually apply a c-collar while he's seizing, I would definitely wait for postictal to do any kind of intervention.

 

[MS Medic]

While the pt is actively Sz, take manual c-spine to protect the head during the Sz and for the fall. After that, once the pt is postictal follow protocols. We have selective spinal precautions here so if the pt fell from a standing position or rolled off a couch and did not hit anything on the way to the floor, I'll usually forgo spinal package because the pt has low likelihood of a spinal injury due to the mechanism. Of course, this decision is dependent on what I find at the scene of each call.

 

[akflightmedic]

Just to clarify, you would hold manual c-spine during the seizure?? How are you protecting the c-spine if they are seizing, even if they did fall and have obvious injury?

Might I suggest you merely move things away from them so they do not injure themselves and possibly place a blanket, pillow or something soft behind their heads.

 

[Qulevrius]

Might I suggest you merely move things away from them so they do not injure themselves and possibly place a blanket, pillow or something soft behind their heads.

^ Pretty much this. And even then, putting anything behind their heads is situational and depends on how violent the Sz is - if they're thrashing about, that pillow will be next to useless. Just let them be and wait for postictal.

 

[MS Medic]

Sorry. Worded that wrong. I typically just have my partner grab the head protecting and padding the occipital area from slamming into the ground. This needs to be done as soon as you see the pt Sz anyway until there is something else padding the back of the head. While my partner is doing that I'm usually administering a benzo to stop the Sz rather than hunting a pillow to replace my partner's hand. This essentially does the same thing as manual C-Spine but like I said last post, unless there is some issue that causes unusual mechanism, I usually don't tend to worry about a fall from a standing position or off a low piece of furniture.

 

[akflightmedic]

I was wondering....

 

[Jim37F]

Last time I encountered an actively seizing patient he was on a concrete pad, so it was important to try to keep hands under his head so he didn't slam it into the concrete and make a bad situation worse...

 

[COmedic17]

I guess it would depend on the situation.

Often times, the seizure is witnessed. Ask the bystander what happened. Sometimes the bystander will of assisted patient to ground, or bystander kind of "slumped" over, etc. I have also arrived on scene and been told by bystanders that the patient was aware a seizure was coming, and laid down prior to onset.

I myself would not put a c-collar on, because the risk of vomiting is to great and I would rather the patient not aspirate vomit. I also don't really see the purpose in trying to manually hold c-spine when someone is flailing around. It kind of defeats the purpose.

If it's an overly violent seizure, I would just fold up a blanket and put it under their head. But I haven't seen many seizures that are violent enough to the point that finding padding for their head was more important to me then trying to stop the seizure. I usually just move objects away from their head.

If it's an active seizure, follow your protocol (benzos) and do an assessment after. 90% of the time, the patient is postictal by the time I get there and I just roll them into recovery position in case they vomit until they start coming around.

 

[RedAirplane]

I was taught to remove dangerous objects from the area surrounding the patient and let him seize. Once he's not convulsing anymore, then consider whatever. You'll make things worse by trying to hold him, finger his mouth, etc.

Try to figure out the medical history and length of seizure for inbound ALS. If it's a short seizure in an epileptic, they probably know the drill. If they're status or it's their first seizure, another story.