Page 61 - 2025 Ranger Medic Handbook

Seizures
A seizure is an uncommon event that can be caused by many different ailments and processes. Not all convulsions be-
come an epileptic condition, and most are brief and self-limited. Seizures are characterized by abrupt onset of abnormal
muscle activity or a prodrome of confusion, peculiar behavior, automatisms, or vivid sights/smells.

Assessment & Management
Assessment: May have sudden onset of loss of consciousness, followed by abnormal motor activity such as tonic SECTION 2
rigidity, clonic rhythmic movements of the limbs, urinary incontinence, frothing at the mouth, and biting the tongue and
mouth; may last seconds to minutes and is usually followed by a period of weakness, somnolence, and confusion (post-
ictal state). Seizures will often spontaneously stop without any intervention after a few minutes. The differential diagnosis
of a convulsive event is extensive: idiopathic epilepsy, alcohol or drug associated seizures, post concussive syndrome,
convulsive syncope, heat stroke, infection (meningitis), brain mass lesions, nerve gas exposure, metabolic abnormalities,
and eclampsia in pregnancy. Wellbutrin, INH, tramadol, and other medications may lower seizure threshold.
Management: Remove the patient from an area where he could injure himself or others. Keep sharp and breakable
objects away from the patient. Pad objects to avoid injury. Do not put anything in the patient’s mouth. Never put your
fingers in the patient’s mouth.
Medications are rarely required to break a first-time seizure. After the seizure, evacuate the patient to an appropriate
treatment facility for a neurological examination and further evaluation. The exam will usually be normal, other than
confusion and somnolence in the immediate postictal period, which may last for hours. After focal motor seizures,
there may be a period of Todd’s paralysis, which is focal weakness of the affected limb. If seizure lasts longer than
5 minutes, then it is considered status epilepticus. These seizures must be stopped ASAP. This is a life-threatening event
and may produce significant brain injury if the patient survives. Emergency medical assistance and intervention must be
rapidly sought. Begin an IV access line. Administer benzodiazepines until the seizure stops or the patient requires airway
management. Midazolam 5mg IV/IO q2–3min/10mg IM q15 min or diazepam 5mg IV/IO q5–10min/10mg IM q15min
for 2 doses. For persistent seizures despite adequate treatment above, confirm no secondary medical cause, continue
benzodiazepines and be prepared to secure airway IAW Airway Management protocol. Evacuate for further imaging and
EEG monitoring if available.
If available, after seizure has stopped, administer a loading dose of levetiracetam 4g IV over 5–15 minutes to prevent
seizure recurrence. If evacuation is delayed > 12 hours after loading dose, administer 1g IV levetiracetam every 12 hours
until patient reaches higher level of care.

Extended Care
Attempt to identify and manage underlying condition prompting the seizure activity. NO DRIVING, WEAPONS HAN-
DLING, OR OTHER DANGEROUS ACTIVITIES UNTIL MEDICALLY CLEARED. Urgent evacuation is not normally
required for a patient with a single seizure that spontaneously resolved. Patients should ultimately be referred for a
nonemergent, ROUTINE neurological consultation.

2025 RANGER MEDIC HANDBOOK 47