VS during active seizures

[Trisherrz]

I justed wanted some advice on how to take a manual BP during an active seizure. I was at capstone and my friend's pt was actively seizing while being brought back to our floor because this happened during a scheduled procedure. When the pt arrived back to us, I just happened to be doing my charge nurse shadow and and went to look at the pt. I was in charge of getting the manual BP but I couldn't hear anything at all, I could only hear the pt's arm banging against the bed and whatnot. I had a Littman cardiology stethoscope too so I mean I had a great instrument.

I guess my question is, am I lacking in skills? I'm usually pretty good with getting a manual BP but in this situation, I was not. I had the charge take over and she said she could barely hear it as well so I'm just wondering if this happens again, how in the world am I supposed to get a BP if I can't hear anything but banging!? Yikes!

[Boomer MS, RN]

You can't get a BP during a seizure. Your main responsibility is to keep the patient safe by removing any thing close that could harm the patient. Although frightening to observe, usually seizures are self limiting. Patient may be confused after the seizure, called the post ictal period. No, you are not lacking in skills. I'm surprised that the charge would even try to get a BP during a seizure! You might want to review nursing care of the actively seizing patient.

[SouthpawRN]

I see absolutely no reason to try and get a BP during a seizure, which is basically impossible as Boomer said. The only vitals signs you need are skins (pulse if you want). If they are cyanotic, (central or peripheral) cold, hot, clammy? Is the pulse regular or irregular, bounding, thready, etc. Everything I need to know to affect my treatment during and immediately following the seizure comes from just looking at and touching my patient.

[KelRN215, BSN, RN]

Add me to the list of people who doesn't see a reason to even try to get a BP during a seizure. I worked pediatric neurology for the first 5 years of my career. Exactly 0 times in those years did we ever try to get a BP on an actively seizing patient.

ETA: Once, I had a patient who started seizing due to increased ICP from hydrocephalus/her EVD was blocked. We did take her BP (widening pulse pressure = an ominous sign when dealing with ICP) but only AFTER we gave her ativan to stop the seizure and it did stop.

[offlabel]

I'd be more interested in why the patient was seizing than his blood pressure.

[Meriwhen, ASN, BSN, MSN, RN]

Answer: you don't.

What you do during a seizure is make sure they don't injure themselves and that they are still breathing. That's all you can during 90% of seizures (the other 10%, you are probably in status epilepticus territory, and that's a whole other ball of wax).

After the seizure activity has ended and they're in the post-ictal state, you can go to town with the VS machine.

[Here.I.Stand, BSN, RN]

You don't take a BP mid seizure; you keep the pt safe, administer Ativan, and ensure that the pt is breathing.

I started my career on a neuro floor, and have since worked in two SICUs which included neuro. I've never attempted a BP -- nor have I seen my colleagues -- on a seizing pt.