Many Americans suffer from some sort of seizure disorder, and as such, they are a fairly common occurrence. Although seizures are usually not fatal events, your situation at the time of the seizure can be dangerous. Just imagine the circumstances if you had a seizure while driving on the freeway, swimming or mountain climbing.

Seizures result from a temporary electrical disturbance in the brain. They can be compared to a hurricane of brainwave activity. During a seizure, the brain sends out multiple mixed messages, much like shaking the contents of your computer's hard drive. Impulses are being sent out, just not in the correct order.

We have identified over 40 types of seizures. The most common type is a grand mal seizure. This is also known as a convulsive seizure. Grand mal seizures are often characterized by violent shaking movements. Many causes have been identified for grand mal seizures. Some of these include drug reactions or abuse, head injury, stroke/brain attack, poisoning or low oxygen levels. Other people have seizure disorders which have no known cause. There are four parts to a grand mal seizure:

1. Aura - Some people are able to identify when they will be having a seizure. This sensory warning sign of an impending seizure may manifest as ringing in the ears, visual disturbances or a funny taste in the patient's mouth.

2. Tonic - This phase is characterized by complete muscle contractions. During this time, every muscle in the body, except the heart, becomes rigid. Breathing is often affected since the diaphragm and other muscles of respiration are involved. The tonic phase usually lasts 30-45 seconds.

3. Clonic - During the clonic phase you will see uncontrolled movements such as shaking and thrashing. Again, every muscle in the body is affected, except the heart. This phase usually lasts 2-3 minutes although it may seem like an eternity. Breathing may be affected due to sporadic contractions of the muscles of respiration.

4. Postictal - The direct Latin translation is "after seizure." This is the time when the patient slowly progresses from unresponsiveness to being fully aware of their surroundings. Your patient will gradually become more lucid and responsive. This is the time to evaluate their ABC's and call for help. The postictal phase can take 20 minutes or more.

The most important thing to remember about a seizure is you cannot stop it from happening. Your focus should be protecting the patient from injury during the seizure. If furniture or objects with sharp edges are nearby, move them away from the patient. If your patient is upright or sitting in a chair, assist them to a lying position and place coats or blankets behind their head for further protection.

Never place any object in the patient's mouth. It was once believed necessary to place a comb or wallet between the patient's teeth to prevent them from swallowing their tongue. Basic anatomy proves it impossible to swallow one's tongue. Problems, such as damage to the teeth, arise from foreign objects in the patient's mouth. This in turn can create airway concerns. Your patient may bite their tongue during the seizure, but you will limit the risks to their airway.

As stated previously, seizures are usually not considered life-threatening. However, there are a few circumstances when 91 1 must be called. A first-time seizure is considered serious because the cause of the seizure is unknown and must be determined. Another serious condition is called status epilepticus or status seizures. This occurs when the patient progresses from the tonic phase to clonic and then back to tonic without ever becoming postictal. The concern here lies in the patient's respirations. We know breathing may be compromised during a seizure due to the muscles of respiration seizing. If the patient is not allowed to relax and resume normal breathing, they will become hypoxic which can lead to death. Treatment for status seizures includes intravenous drugs such as Valium to break the seizure cycle.

There are also non-convulsive seizures, sometimes called petit mal or absence seizures. The evidence of these includes staring attacks with an accompanying lack of awareness, or partial seizures, which are characterized by semi-purposeful movements lasting for just a few minutes. Treatment for these is almost non-existent. Simply stay with the patient and be supportive as they gain their awareness. Always be alert for changes in their ABC's.

A good rule of thumb with seizures is to identify any first-time seizure as a lifethreatening event. Pregnant women having a seizure or any seizure that lasts more than 5 minutes also require EMS intervention. Always protect your patient, allow them to have their seizure and monitor ABC's as soon as the seizure is over. Remember, never, EVER put anything in the patient's mouth during a seizure.

placing a seizure patient on their side reduces the risk of aspirating vomit. the recovery position allows you to safely place medical patients on their side in emergency situations.