Emergency situation-- how should I have handled it?

Wuzzie · Feb 16, 2018

Essentially you did just fine. Outside of the hospital all you can do for seizures is protect the patient from injury, position to help maintain an airway and call 911. All of which you did. The only thing I would have done differently is to direct someone to call 911 before calling your boss. The patient needed a medic not your boss. Cyanosis is not uncommon during and for a short period after a seizure. As long as the patient is breathing they usually pink up pretty quickly but it's very scary to see. And don't feel bad. I have transported many kids that were unnecessarily intubated post-seizure for that very reason. It's hard to say if she was truly pulseless or not. Sometimes peripheral pulses are hard to find and people's adrenaline surge doesn't help the situation. Honestly she probably didn't CPR but I wasn't there so I could be wrong. Overall I think you did great.

And if you remember nothing else always remember...

AIRWAY! AIRWAY! AIRWAY!

ksola · Feb 16, 2018

Thank you. Like I said, my other coworkers are only CPR/FA trained and I remember when I started school I used to have trouble finding pulses so I don't blame them for possibly not being able to find it. Honestly, that was where I was kicking myself cause I probably would've been more effective staying with her and monitoring her.

As far as calling boss before 911, I do agree. But we are also used to seeing seizures (a lot of our clients have seizure disorders) where it's like, okay keep them safe and time it. Some even have protocols where if it's under 2 minutes or 2 within a 12 hour period they don't even have to be taken to the ED. So the call to my boss was made when we were still questioning, does she have a history of seizures? (and also its via intercom, she was in another part of the same building). It was when we realized no, and that she was cyanotic that we called. Would you say that for someone who's never had a seizure before, we should have called immediately when we realized she was seizing?

Thank you for the reassurance too. Like I said, this was my first situation as an active participant and it was honestly much more nerve wrecking than I would've thought. It had me doubting my abilities to act effectively in a crisis situation, which is something a nurse needs to be able to do.

Guest374845 · Feb 16, 2018

I think you did great. The worst thing to do would be to over-think in a situation like yours and miss the basics. For the future, check a pulse in anyone who looks like they're "seizing". Hypoxia from a non-perfusing heart rhythm can mimic one.

FazzDazzle · Feb 16, 2018

Remember it's not ABC but CAB in all situations. In the ED we deal with a lot of seizing people, it's scary at first but you soon learn. Check a carotid pulse or radial pulse (it's hard when people are seizing but pulse rates tend to go up, and dead/pulseless people often don't move), then I check their airway. Seizing people often clamp their jaws down far back and so what I do is a hard jaw thrust maneuver if they look like they aren't breathing well. (Not everyone does this but I do. Having worked in surgery I learned this will increase oxygen saturations more than just slapping oxygen on them and you can assess if/when they respond to pain because it kinda hurts.) Then have someone call 911 and grab a nonrebreather mask. Talk to the person and tell them they are okay and it'll be over soon, even if they can't hear you, you are supporting yourself and the staff with calm reassurance. Once the seizure is over people are often scared and hard to difficult to re-orient for a bit (post-dictal).

It doesn't sound like you did anything wrong. Seizures are, honestly, one of most intimidating things that you can experience as a nurse. One time I had a girl that had seizures for 40 minutes that after 10mg of ativan, 50mg of benadryl and 1gm of keppra. I felt so bad for this girl until the seizures stopped. After the keppra she began to fake seizures. It turns out she has borderline personality disorder in addition to seizures. She would stop taking her meds so that she would have her seizures. She went to the icu based on her condition, but I'm pretty sure she left ama based on what I heard.

JKL33 · Feb 16, 2018

So some background, I'm a nursing student. Two semesters into a 16 mo program. I also work in an unskilled facility for adults with ID. That's where this situation took place. There are no nurses, only training we all have is First Aid and CPR.
A client suddenly tensed up and dropped to the ground. I ran over and realized she was having a seizure. I yelled out asking if anyone knew if she had ever had one before cause to my knowledge she had not. She was already laying on her left side so I looked to the clock to start timing (unfortunately it had no second hand and of all days I had forgotten to wear my watch) while someone placed a coat under her head. Someone called up to my boss to let her know, and she was on her way down. I noticed her face was pale and ashen, then she started to become cyanotic. At this time I told my coworkers (there were about 6 of us around) that I was calling 911. By the time I connected, someone stated she didn't feel a pulse and they started CPR. She started breathing again, they put her in the recovery position and her color came back. EMS arrived and she was regaining consciousness.
My question is, looking back I keep thinking there's more I could've done. I know I don't have much training, but I do have enough where I should've been able to take a more active role. I've had ABC's and priority assessments drilled into my head enough times. I keep thinking, I should've had someone else call while I took a few seconds to assess the situation. I don't feel like I handled the situation as well as I could've. I've only ever been an observer of codes (and even then, I was far back and only got there towards the end). My mind went blank and I forgot practically everything I've ever learned.
So my question is, as a nurse, how would you have handled this situation? What could I have done? And if a situation like this happens again (in or out of the hospital) what should I hold onto in my mind as the "if you remember nothing else, remember this"?

You did a great job and some of what you are feeling/thinking are the normal after-effects of experiencing your first situation like this. It's okay, really....truly. You did a fine job.

There isn't much that I would do entirely differently...so much so that I don't think you should pick this situation apart too much - next time you encounter something it won't be exactly the same.

It sounds like you and your coworkers worked together and pretty much covered the basics. Very nice. :up:

AnnieOaklyRN, BSN, RN, EMT-P · Feb 16, 2018

Hi,

As far as seizures go they are usually self limiting and just making sure the patient is safe on a flat surface and not at risk of falling is basically all you can do.

You should just leave them as is, there is no need to move them to there side during the seizure or put anything in their mouth etc. Calling 911 was the smart thing to do.

Also be aware some patients have seizures when they initially go into cardiac arrest, usually if they are in VTach or Vfib, and will present very similar initially to someone who is just plain having a seizure. Just be aware of this and I recommend if you have an AED you have someone go get it just in case, don't put it on unless they have no pulse of course.

Annie

ruby_jane, BSN, RN · Feb 16, 2018

You've gotten a lot of good information here. Don't spend much more time second-guessing. Next time you'll know what a seizure looks like and you'll react with more confidence.

Editorial Team / Moderator · Feb 17, 2018

How I would handle this as a nurse has no bearing on how you handled it - which was just fine, by the way!! Outside of a hospital the only equipment I carry is a tourniquet in my bag. If you're bleeding, I got you. For a seizure, there is little I could do but what you did - keep her safe and call in some resources. Nice job! You should feel good about helping, and I hope you do. :)