Question 1

When an EMT performs the secondary assessment on a postictal seizure patient with a known history of seizures, what assessment finding would be of most concern?

Accepted Answer

D

Question 2

While placing a 52-year-old female on the stretcher, she begins to seize. Your immediate action would be to:

Accepted Answer

During a seizure, the immediate priority is to ensure the patient's safety. Loosely applying the straps and raising the side rails on the stretcher helps prevent the patient from falling or injuring themselves without restraining their movements too tightly, which could cause harm. Rapid transport, airway management, or moving the patient to the ground are not the first actions to take before ensuring the patient's safety on the stretcher.

Question 3

A postictal patient is awake but has trouble answering your questions correctly. Given this presentation, the EMT would recognize that:

Accepted Answer

A postictal patient who is awake but disoriented or confused is still able to maintain their own airway, so ensuring the airway is open is not a concern. The fact that the patient is postictal indicates they have a history of seizure activity, so choice C is correct. Another seizure may or may not be coming, but there is no indication in the scenario to suggest that it is imminent, ruling out choice B. High-concentration oxygen is not indicated in this scenario, so choice D is incorrect.

Question 4

You have been called to a public bus station for a behavioral emergency. On scene you find a disheveled male in his forties sitting up against a wall. He is confused and incontinent. Bystanders state that he suddenly began to stumble around, shouting obscenities, and then fell to the ground spitting and shaking. From this description, the EMT should be suspicious of what condition?

Accepted Answer

The sudden onset of confusion, incontinence, and uncontrolled movements after initial shouting and aggression suggest a possible generalized seizure. Alcohol intoxication may cause similar symptoms but usually shows a slower onset and may not involve spitting or shaking. Absence seizures typically do not involve physical movements, while syncope (fainting) does not usually involve confusion or incontinence.

Question 5

As a general rule, a postictal patient should be placed on the stretcher and transported in what position?

Accepted Answer

The lateral recumbent position is the ideal position for a postictal patient to prevent aspiration of any secretions or vomitus. This position also allows for optimal airway patency, as well as allowing for any seizure activity to continue without interference. It is also important to protect the patient's head and neck during transportation.

Question 6

When performing the secondary assessment on a confused patient, which one of the following signs would be most suggestive of a seizure?

Accepted Answer

A bleeding tongue can suggest a seizure because the patient may have bitten their tongue during the seizure activity. Bruises may suggest some kind of trauma, pinpoint pupils may suggest drug use, and warm skin does not necessarily provide any indication of a seizure.

Question 7

You are caring for a postictal male patient with a known history of seizures. He is confused and cannot remember his 8-year-old son's name. His son tearfully asks you if his father will ever remember him. Your response would be:

Accepted Answer

This response provides reassurance to the child that his father's memory loss is temporary and that he will likely remember his son's name once he recovers from the postictal state. It also reflects empathy towards the child's concerns.

Question 8

When obtaining a medical history from the family of a seizure patient, what question is most important for the EMT to ask first?

Accepted Answer

It is important for the EMT to first determine if the patient is on seizure medication and if they are taking it as prescribed, as this information can significantly impact the patient's current condition and the potential usefulness of certain interventions.

Question 9

After a lengthy response, you arrive at the home of a 62-year-old female who is still seizing. Your immediate action would be to:

Accepted Answer

The first priority in any medical emergency is to assess and maintain the patient's airway and breathing. In the case of a patient who is still seizing, it is important to ensure that their airway is open and that they are able to breathe effectively. Once the patient's airway and breathing have been assessed, further assessment and treatment can be provided as necessary.

Question 10

You are to transport a 46-year-old male who has had multiple seizures throughout the morning. Currently, he is on your stretcher and is postictal. He has a history of seizures for which he takes anticonvulsant medications. He also suffers from diabetes and kidney failure. Of the equipment listed below, which one is most essential to have ready during transport of this patient?

Accepted Answer

The most essential equipment to have ready during transport of this patient is a suction device. The patient has a history of seizures and is postictal, which places him at risk for aspiration of vomit or secretions. Aspiration can lead to respiratory distress or even respiratory failure. A suction device can be used to quickly and effectively clear the airway if the patient begins to vomit or has excessive secretions. While the other equipment listed may be useful for other situations, they are not essential for this patient in this specific scenario.

Question 11

As you approach a female patient, she appears unresponsive with her arms and legs jerking violently. On the prehospital care report, you would document that the patient was found in what phase of a generalized seizure?

Accepted Answer

During the clonic phase of a generalized seizure, the patient will often experience rhythmic jerking movements in their arms and legs. This description matches the scenario presented in the question. The tonic phase of a seizure is characterized by stiffening of the body, while absence seizures involve a brief loss of consciousness. Syncopal events are caused by a sudden drop in blood pressure, and do not typically involve convulsive movements.

Question 12

The initial part of a generalized seizure experienced by some patients is called the:

Accepted Answer

The initial part of a generalized seizure experienced by some patients is called the aura. The syncopal stage refers to fainting or passing out, and the clonic phase refers to the stage of convulsions. The postictal state is the period after a seizure where the patient may feel confused, fatigued, and disoriented.

Question 13

You are called to a residence to assess a child. The panicked parents state that their 3-year-old son was playing with his brother when he suddenly "blanked out" and would not respond to them for several seconds. When asked, they deny any convulsing-like movement as well as a history of medical problems. Based on this description, you would be suspicious of what type of seizure?

Accepted Answer

The child's sudden "blanking out" and not responding for several seconds is a classic presentation of an absence seizure, also known as a petit mal seizure. Febrile seizures are typically characterized by a sudden fever and can involve convulsions, but the parents did not report a fever or convulsions. Simple partial seizures typically involve specific motor or sensory symptoms, and the parents did not report any specific symptoms. Grand mal seizures involve convulsions, which the parents denied.

Question 14

Friends of a male patient who suffered a generalized seizure are worried because he cannot remember the seizure. You should inform them that this is a(n):

Accepted Answer

Memory loss or confusion is a common finding after a generalized seizure, and it is not uncommon for a patient to have no memory of the seizure itself. However, it is important to assess the patient's level of consciousness, airway, breathing, and circulation and seek medical attention if necessary.

Question 15

You find a patient, who seized for approximately 2 minutes, supine on the kitchen floor. He responds to painful stimuli and has snoring respirations. Emergency Medical Responders are holding manual in-line spinal stabilization and report the following vital signs: heart rate is 124 beats per minute, and his pulse oximetry is 89% on room air. He has cool and clammy skin. Which one of the following should you do first?

Accepted Answer

The patient's snoring respirations indicate a compromised airway, likely due to the tongue falling back and obstructing the airway. The jaw-thrust maneuver is the most immediate action to open the airway without moving the cervical spine, especially important since spinal injury has not been ruled out.

Question 16

You have been called for a seizure emergency. On scene you find an adult female actively seizing with bystanders attempting to restrain her. You would:

Accepted Answer

Instructing the bystanders to release the patient is correct because restraining a seizing person can cause injury. Instead, ensure the area is safe and protect the patient from harm.

Question 17

How would you transport a seizure patient who may have a spinal-cord injury?

Accepted Answer

In the case of a seizure patient who may have a spinal cord injury, the best way to transport them is to immobilize them completely on a spine board with a cervical collar in place. This is to prevent any further injury to the spinal cord during transportation. The patient should also be secured to the board properly to prevent any movement. The other options are not appropriate for a patient with possible spinal cord injury.

Question 18

A young boy tells you that his twin brother suffers from seizures and asks what he can do if he sees his brother convulsing. Your response would be:

Accepted Answer

The answer of A young boy tells you that his...

Question 19

You are by the side of an alert but confused 41-year-old woman who is diaphoretic and appears exhausted. She informs you that she has a history of seizures and just had a generalized seizure. Despite your urging, she refuses transport to the hospital. Your safest action would be to:

Accepted Answer

As the patient is experiencing post-seizure confusion and diaphoresis, it is important to advise medical direction of the situation for further guidance. The patient is at risk of further complications and medical attention may be required. Transporting the patient against their wishes could result in legal issues and is not the safest option. Contacting law enforcement is also not necessary unless there is a risk of harm to the patient or others. While recognizing a seizure history and having the patient sign a refusal form is important, it should not be the only action taken in this situation.

Question 20

A female patient with a history of seizures has suffered a seizure in a public area and is now refusing further assessment and transport. As you leave, a witness to the entire event tells you that he thinks the patient is "crazy in the head" because right before she seized, she looked up toward the ceiling and kept repeating, "Do you see the birds?" As a knowledgeable EMT, you should recognize that the bystander is describing what condition?

Accepted Answer

The bystander is describing an aura, which is a subjective sensation or unusual behavior that can occur prior to a seizure. Auras can manifest in a variety of ways, such as visual disturbances, strange feelings, or repetitive behaviors. The patient's behavior and comments suggest that she may have had a visual aura in the form of seeing birds before her seizure.

Quiz 19: Seizures and Syncope