Medical Emergencies: Seizures, Diabetic Crises & CVA Overview

OBJECTIVES

Upon completion of this lesson, you will be able to:

1. Define seizure.
2. List four steps for the pre-hospital treatment for seizures when arriving while the patient is still having a seizure.
3. List five additional steps for the pre-hospital treatment for seizures to take after the seizure is over.
4. List seven signs and symptoms of hyperglycemia and list three steps for pre-hospital treatment.
5. List nine signs and symptoms of hypoglycemia and describe pre-hospital treatment.
6. List nine signs and symptoms of a cerebral-vascular accident (CVA).

1. Seizures

Definition: A sudden and temporary change in mental status caused by massive electrical discharge in the brain.

Seizures are caused by a malfunction. If the normal functions of the brain are upset, its electrical activity can become irregular. A seizure can cause a sudden change in a person’s sensations, behavior and/or movements. Some seizures involve uncontrolled muscular movements called convulsions. Having seizures is not a disease in itself, but rather a sign of some underlying defect, injury, or disease.

Causes:

• Epilepsy: A chronic neurological condition that causes recurrent seizures.
• Fever (Febrile Seizures): Common in young children due to a rapid rise in body temperature.
• Head Trauma: Brain injuries or hematomas can lead to seizures.
• Stroke (Cerebral Vascular Accident): Disruption of blood supply to the brain can trigger seizures.
• Infections: Conditions like meningitis or encephalitis that affect the brain can cause seizures.

This lesson will cover three of the more common causes of seizures: epilepsy, fever, and head trauma.

Epilepsy

Epilepsy, an unpredictable neurological illness, is perhaps the best known as one of the conditions that causes seizures. Some people are born with it and others develop it after a head injury or surgery. Conscientious use of medication allows most epileptics to live normal lives without seizures. Epilepsy can present itself in different forms. Some episodes of convulsions are severe (called grand mal) and some convulsions are almost undetectable (called absent or petit mal). An epileptic convulsive episode can repeat an indefinite number of times.

Febrile seizure

Fever is a common cause of seizures in children less than years of age. It is the rapid rise in body temperature, rather than the temperature itself, that causes the seizure. The seizure can repeat many times. All children who have suffered a seizure require medical evaluation.

Head trauma

A patient with a brain injury may have a seizure immediately or it might be delayed. A hematoma may form inside the skull, causing increased pressure and resulting in a seizure. It is very important to obtain a thorough patient history to determine whether the patient has fallen or received any type of head trauma.

Phases of a seizure

The most common type of seizure you will respond to is a grand mal (generalized) seizure. There are four phases in this type of seizure:

• Aura phase: The patient becomes aware that the seizure is coming on, usually described as an unusual smell or flash of light, and usually lasting only a second.
• Tonic phase: The patient becomes rigid and collapses. All the muscles of the body contract. The body becomes rigid and the patient may stop breathing. May become incontinent.
• Clonic phase: The patient convulses violently. May foam at the mouth or drool, and may become cyanotic.
• Postictal phase: Begins when convulsions stop. The patient gradually regains consciousness. Headache is common.

Other common signs and symptoms for less severe seizures:

• Temporary loss of concentration or awareness
• Atypical behavior
• Tingling, stiffening, or jerking in one part of the body, which may later spread

A continuous seizure or two or more seizures without a period of responsiveness is called status epilepticus. This is considered a true medical emergency, and can be fatal. Transport the patient immediately.

Pre-hospital treatment for seizures

Use universal precautions and secure the scene. If you arrive while the patient is still having a seizure, begin at Step 1. Otherwise, go to Step 5.

1. Place patient gently on the floor and move any objects that patient might strike.
2. Stay calm and wait. Do not force anything into the patient’s mouth. The seizure should be over in a few minutes.
3. Loosen restrictive clothing. Do not restrain the patient.
4. Place the patient on his/her side to prevent aspiration.

If you arrive after the seizure is over, begin at Step 5:
5. Assess and monitor airway and breathing.

6. Treat any injuries the patient may have sustained during convulsions.
7. Place the patient in recovery position (only if you do not suspect spinal injury).

Basic Medical Course

8. Administer oxygen per local protocol.
9. Comfort and reassure the patient.

For febrile seizures in children, lower the patient’s temperature using tepid water and a bath sponge or washcloth. Transport the patient.

2. Diabetic Emergencies

Diabetes is an illness caused by deficient production of insulin in the body. Your task as an MFR is not to diagnose or treat diabetes, but rather to recognize and manage the conditions caused by the improper management of diabetes. These conditions are known as hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar). The most common indication that the patient may have either of these conditions is altered mental status. Other clues, such as a necklace, bracelet, medication, or information provided by others, may also provide vital information.

Some hyperglycemic and hypoglycemic patients may appear to be alcohol-intoxicated. Always suspect a diabetic problem even in cases that appear to be only alcohol- or drug-related. As we will also see, blood sugar problems are not always related to a diabetic condition.

2.1 hypoglycemia

Diabetics may suffer from increased blood sugar, or hyperglycemia. This condition is basically one of too much sugar and too little insulin. Common causes of hyperglycemia include:

Signs and symptoms of hyperglycemia

• Gradual onset of altered mental status.
• Excessive thirst (polydipsia).
• Excessive urination (polyuria).
• Excessive hunger (polyphagia).
• Intoxicated appearance, staggering, slurred speech without alcohol consumption.

The onset of severe hyperglycemia is gradual. In most cases, it develops over a period of several hours. At first, the patient experiences excessive hunger, thirst, and urination. The patient appears extremely ill, becoming weaker and worsening as the condition progresses. If left untreated, the patient may die. Even with treatment, recovery is slow, occurring 6 to 12 hours after insulin and intravenous fluid are administered. A hyperglycemic emergency is also called a diabetic coma, although the patient is not usually found in a coma

Pre-hospital treatment for hyperglycemia

Use universal precautions, secure the scene and alert local EMS. Never give patients who cannot control their airways anything to eat or drink.

1. Perform initial assessment and obtain patient history.
2. Administer glucose per local protocol. When in doubt, give sugar.
3. Reassess and transport the patient. Position the patient appropriately.

2.2 Hypoglycemia

This condition consists of low blood sugar, and can be the result of one or two conditions. One is too much insulin in the bloodstream. The other is too little sugar in the bloodstream. People with diabetes are not the only ones who can suffer from low blood sugar. Alcoholics, anyone having ingested certain poisons, and people who are ill are also at risk.

Some common causes of low blood sugar are:

• Excess insulin: Administering too much insulin can rapidly lower blood sugar levels.
• Skipping meals: Not eating enough after taking insulin or diabetes medication.
• Excessive alcohol consumption: Alcohol can interfere with the liver’s ability to release glucose into the bloodstream.
• Intense physical activity: Prolonged or vigorous exercise can deplete blood sugar levels, especially without adequate carbohydrate intake.
• Certain medications: Drugs like beta-blockers or antibiotics can sometimes cause hypoglycemia.

 

The onset of severe hypoglycemia is sudden. The most recognized cause of hypoglycemia is insulin overdose by a patient with diabetes. After time, diabetes causes visual impairment in patients. This can make it very hard for patients to give themselves the proper amount of insulin. The result is an insulin overdose and hypoglycemia.

Signs and symptoms of hypoglycemia

• Rapid onset of altered mental status: A sudden change in mental clarity or awareness.
• Intoxicated appearance: Staggering, slurred speech, similar to alcohol intoxication.
• Atypical behavior: Unusual actions, such as confusion or inappropriate responses.
• Combativeness and/or anxiety: Aggressive behavior or intense nervousness.
• Sweating (diaphoresis): Profuse sweating, often cold and clammy.
• Pale skin: The patient may appear unusually pale.
• Shaking or tremors: Involuntary trembling of the hands or body.
• Fatigue or weakness: A sudden feeling of extreme tiredness or weakness.
• Hunger: An intense or sudden urge to eat, often described as feeling ravenous.

Pre-hospital treatment for hypoglycemia

Use the same treatment as for hyperglycemia.

2.3 Cerebral Vascular Accident (CVA)

Definition: A sudden loss of blood supply to the brain.

CVA, commonly known as a “stroke,” is also becoming known as “brain attack.”

Causes of CVA

• Cerebral thrombosis: The result of a clot obstructing a cerebral artery, preventing the flow of oxygenated blood to a portion of the brain.
• Cerebral hemorrhage: The result of a cerebral artery breaking, leaving an area of the brain without blood supply. The blood that comes out of this artery creates intracranial pressure to the brain and interferes with the brain’s functions.

Signs and symptoms of CVA

These vary depending on the location and extent of damage:

• Headache – may be the first and only symptom
• Fainting (syncope)
• Altered mental status
• Tingling or paralysis of the extremities or face
• Difficulty speaking
• Blurred vision
• Convulsions and/or seizures
• Unequal pupils
• Loss of bladder or bowel control

If any one of these signs or symptoms is present, assume that the patient is having or is about to have a cerebral vascular accident.

Pre-hospital treatment for CVA

Use universal precautions and secure the scene.

1. Instruct the patient to stop all movement.
2. Place the responsive patient in a comfortable position, usually semi-reclining or sitting.
3. Maintain open airway.
4. Administer oxygen per local protocol. If needed, provide artificial ventilation or CPR.
5. Loosen restrictive clothing.
6. Maintain body temperature as close to normal as possible.
7. Comfort and reassure the patient.
8. Constantly monitor the patient’s vital signs.

In managing medical emergencies such as seizures, diabetic crises, and cerebral vascular accidents, prompt recognition and appropriate pre-hospital care are critical to improving patient outcomes. Understanding the signs and symptoms of each condition—whether it’s the phases of a seizure, the telltale indicators of hypo- or hyperglycemia, or the warning signs of a stroke—enables responders to act quickly and effectively.

Following standardized treatment protocols ensures the patient’s safety and stability while awaiting further medical intervention. By mastering these essential skills, medical responders can provide life-saving support during some of the most critical moments, enhancing their ability to deliver compassionate, effective care.