A couple months ago I was working with Vanessa in a coffee shop, when it seemed all eyes had turned to the floor under one table. The group gaze pointed to a student who was having a seizure. I went over to hold him on his side to keep him from choking on vomit or saliva, and also to protect his head and limbs from banging against the metal window frame. That’s it. That was cutting edge bystander first aid for seizures. Checking for a pulse is just added finesse to build bystander confidence.

911 was called by another bystander and I tried to help the student regain consciousness in time to save him an expensive ride. But no luck. He was transported to the ER where I’m told he eventually awakened and left after a thorough workup. He’d had seizures before apparently, and he’d had a particularly energetic night prior.

This experience made me realize how challenging a life with epilepsy must be. One minute having a coffee with a friend enjoying a pleasant weekend, and the next minute waking up in a hospital, and out a few thousand dollars for ambulance transport and ER care.

I’d be called wreck-less for advising against transport, but it’s safe for me to reveal my inner sense of worthlessness for patients who arrive having had a seizure. “Ran out of my meds” and “recently stopped drinking” are the top two reasons I encounter.

Red Flags:

• No past seizure history
• Ongoing uncontrolled seizures
• Multiple
• Head injured
• Signs of infection
• Cancer
• Taking blood thinners
• Hydrated with 3 liters of water after running a marathon

Happy Words

• Uninjured
• Brief
• No longer postictal (meaning confusion has resolved)
• Back to normal
• “I have epilepsy and this is like my past seizures.”
• “I ran out of my Dilantin.”
• “I decided to stop drinking cold turkey.”

Brains are webs of wires in a chemical soup. A disturbance in one region can cause perceptions/feelings/actions as small as a brief hallucination, a tingling hand, or a brief fixed gaze (“absence”). Such disturbances rarely make their way to ERs. It’s the “tonic-clonic, grand mal” seizures that draw a crowd and paramedics. However, while dramatic, the large majority of these still resolve on their own.

From the ER I’m stuck and I’ll keep ordering electrolytes, sometimes Dilantin, Valproate, Tegretol levels and the occasional head CT, because batting 1000 is expected of us. However, if you are with someone who just had a seizure, or if you just had one yourself and you’d like to have a chat, feel free to give Pre-R a call. Most likely we’ll suggest rest, preferably near loved ones, no stimulants (or intoxicants), and perhaps taking another dose of your regular anti-seizure meds. At very least we’ll let you know what you may expect should you call 911.

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