The status seizure requires immediate ALS intervention

A status seizure is a seizure that continues through the post ictal phase. When a typical seizure lasts 30 seconds or less, the status seizure can last 5 to 15 minutes; or literally just continue until the patient is dead. Despite the fact that status seizures are rare, paramedics should be available to treat the patient with benzodiazepines.

Sometimes infants stop breathing during and after a seizure

There are variations of seizure activity that result in apnea, sometimes as a component of the seizure and other times as a component of the post ictal phase. It’s possible that the medics may encounter an apneic infant and through deduction, are able to understand the patient had a seizure. It would be helpful for the medics to know that each breath they give via bag valve mask is getting the patient one step closer to regaining conscious and breathing on their own.

Infant seizures are generally first time seizures and require intense medical investigation

Nearly every cause of altered mental status has a definitive test. When the ambulance crew assesses a patient with altered mental status, they will not have the advantage of a myriad of clinical tests. What the ambulance crew needs is an easy way to assess common causes of altered mental status. When the patient is conscious, the ambulance crew should use the SPASTIC pneumonic:

Sugar – Check patients blood glucose level

Poisons/Pregnancy – Inquire about the possibility of poisoning. A condition associated with pregnancy called eclampsia can cause seizures.

Alcohol – Do the rescuers smell alcohol?

Trauma – Is there a history of a head injury?

Stroke – Could the patient be having a stroke

Infection – Is the patient running a fever?

Crack or other drugs – Is the patient on drugs?

Management of pediatric seizures

Initial management is guided by the primary survey. For the most part, EMS will find the patient experiencing the post ictal phase of the seizure. If the seizure is a status seizure, an ALS unit should be dispatched immediately so the paramedics can administer benzodiazepines. The post ictal phase is primarily caused by hypoxia. Administering high flow oxygen by mask is a great way to decrease the post ictal phase of the seizure. Next, the medics need to explain the seizure. Explaining why a seizure happens because the patient forgot to take their medications or sometimes has a breakthrough seizure is very easy to do. The first time seizure is a little more difficult. Between the SAMPLE history and the SPASTIC pneumonic, the medics should be able to explain why the seizure happened. EMS can be a critical link to determining the cause of the seizure.