Medical Emergencies
Epileptic Seizure
This page discusses Epileptic Seizure, an emergency that can usually be readily managed by a prepared dental team should a patient have an attack at the dental surgery. Note that the term "epileptic seizure" is now considered old-fashioned (as there can be other causes), and just the word "seizure" should be used.
How to Treat Seizures In Children
I understand. Do not show this message again.
In this video, viewers are guided through the important first aid steps to take when assisting a child experiencing a seizure, likely due to epilepsy. The presenter offers reassuring words to a child named Harry, indicating that it is important to remain calm during such episodes.
The main focus of the video is to emphasise the safety of the child during a seizure. Viewers are instructed to protect the child from injury by ensuring their surroundings are safe, while firmly advising against restraining them in any way. Once the seizure has concluded, the video highlights the importance of helping the child rest in a safe position—specifically on their side with their head tilted back. This is very important for maintaining an open airway and preventing any complications.
Overall, the video serves as a concise reminder of the essential steps to take in supporting someone during a seizure, prioritising safety and comfort.
If you prefer to view this page as didactic information, rather than as a self assessment, click the arrow below.
Didactic Information:
Click here
Epilepsy is a common neurological disorder. It is a chronic condition which results in recurrent seizures due to abnormal neuronal activity in the brain. The seizures can be controlled in 70% of patients with medication.
Seizures are normally unprovoked, but they can be triggered in some (but not all) people with epilepsy. Flashing lights and hyperventilation are common triggers.
The severity of a seizure is variable, ranging from disorientation to collapse to convulsions.
Types of seizure
Simple partial seizure. The patient may be hallucinating, confused, and disorientated.
Complex partial seizure. The patient may become unconscious.
(Partial seizures are sometimes called “Petit Mal”.)
Tonic-clonic seizure. The patient is unconscious and convulses. (Also known as “Grand Mal”)
Signs and symptoms of tonic-clonic seizure
There may be an “aura”
Sudden loss of consciousness, the patient becomes rigid, falls, may give a cry, and becomes cyanosed (tonic phase).
After a few seconds, there are jerking movements of the limbs; the tongue may be bitten (clonic phase).
There may be frothing from the mouth and urinary incontinence.
The seizure typically lasts a few minutes; the patient may then become floppy but remain unconscious.
After a variable time the patient regains consciousness but may remain confused.
Precautions
Check medical history. To assess the risk, ask the patient about the type of seizures they have had, their frequency (for example the last three), and when they most recently had one. If they have recently changed their medication or dose, they may be more likely to have a seizure. If patient normally gets an Aura, instruct them to warn you should it arise.
Ask the patient about known triggers for a seizure.
Management of tonic-clonic seizure
Note the time the seizure starts.
Prevent self-injury by moving the patient away from sharp edges.
Put something soft beneath the head.
Roll the patient carefully into the recovery position (to prevent asphyxiation).
If the patient starts to be sick, allow the vomit to drip out of their mouth by itself.
Do not place any object into the mouth: the patient is more likely to bite their tongue (and your finger) if you do this.
Monitor the patient until full recovery has been made. If the patient has not recovered after five minutes, or the seizures seem to be coming in waves, call an ambulance. (Prolonged seizures may precipitate Status Epilepticus, a very serious condition.)
While waiting for the ambulance during prolonged seizures, consideration should be made of administering buccal Midazolam. The administration of Buccal Midazolam for the control of prolonged or continuous seizures is an effective treatment which can be lifesaving. Given promptly this relatively simple procedure can prevent the major disruption to daily life resulting from hospital emergency treatment. (NICE, 2016 Clinical Guideline 137).
Midazolam dose:
10 mg (Adults, children over 10)
7.5 mg (Children 5-10 years)
5 mg (Children 1 – 5 years)
Self Assessment
Briefly, what is epilepsy, and how many patients with epilepsy can have their seizures controlled with medication?
What triggers a seizure?
Broadly, what types of epileptic seizure exist?
What are the signs and symptoms of a tonic-clonic seizure?
What precautions can be taken if you are seeing a patient known to have epilepsy?
How would you manage a tonic-clonic seizure?
Buccal Midazolam
I understand. Do not show this message again.
In this video, Dr. Peter Bergen, a neurologist with expertise in epilepsy management, demonstrates the administration of buccal midazolam, a medication used in emergencies to terminate seizures or prevent their recurrence. Originally developed as a sedative, midazolam can be effective when administered through the buccal route, providing a non-intrusive method that allows for the quick absorption of the medication.
The video outlines the packaging options for midazolam, noting that plastic ampules are becoming more common due to their ease of use compared to glass ampules. Each ampule is labelled with essential information, including the medication's name, dosage, and expiration date. The presentation emphasises the importance of having a current first aid certificate, knowledge of CPR, and an understanding of the individual’s epilepsy plan before administering the medication.
Dr. Bergen gives a step-by-step guide on how to administer the medication, emphasising the need to monitor the time of seizure onset and follow specific protocols. The medication is to be administered slowly between the lower cheek and teeth, ensuring it is absorbed rather than swallowed. After administration, it's vital to place the person in a recovery position and maintain a clear airway while waiting for the seizure to subside.
The anticipated effects of the medication are discussed, including the possibility of the individual becoming sleepy or experiencing mild dizziness. Dr. Bergen reassures viewers that while the effects may take several minutes to manifest, any absorbed medication will be beneficial. In the case of prolonged seizures, further doses may be considered, but such decisions should be coordinated with a physician beforehand. The video concludes by stressing the importance of monitoring the individual and adhering to standard first aid practices until recovery is achieved.