Signs/symptoms: Seizures, or convulsions, may produce generalized skeletal muscle contractions. Seizures in the dental office may occur due to epilepsy or can be induced by local anesthetic overdose. Most common seizure is grand mal seizure (generalized tonic-clinic seizure - GTCS):
- Prodromal phase (few seconds to a few hours): patient may experience an aura - a peculiar smell or taste, a vision or a sound.
- Tonic phase: Patient loses consciousness, and experiences a brief (10-20 seconds) period of generalized muscle rigidity.
Generalized muscle contractions and relaxations usually follow, lasting from 2-5 minutes.
- Postictal phase: Muscle contraction ends, and the CNS and respiratory system become depressed from 10-30 minutes.
The patient is sleeping deeply and is difficult to arouse. They may snore, indicating partial airway obstruction.
Full recovery from GTCS requires up to three hours.
Status epilepticus is an acultely life-threatening situation in which the siezure continues for more than five minutes, or stops & returns before the patient regains consciousness.
Management of seizures:
If a seizure occurs during treatment, leave the patient in the dental chair and remove all dental equipment as quickly as possible. Do not put anything in the mouth of a convulsing person - most seizure-related injuries occur when rescuers try to insert objects into the mouth, trying to "protect" the person from injury.
- Contact the EMS immediately - this assures prompt response and accurate evaluation of the patient after the seizure. Not all seizures stop within five minutes. Continuing seizures are life-threatening.
- Place in supine position. Foot elevation is not critical.
- Rescuer 1 - arms - gently!
- Rescuer 2 - legs - gently!
- Rescuer 3 - airway (Remove dental chair pillow to help maintain airway)
- Basic life support. Breathing & circulation normally are not impaired during seizures.
- Basic life support becomes critical after the seizure, during the postictal phase. If snoring is heard (partially blocked airway), use head tilt.
- Only professionals specifically trained in managing apneic patients should administer anticonvulsants. EMS personnel are trained to administer these drugs.
- Postictally, patients are disoriented & sleeping deeply. Talk to the patient. Explain they are in the dental office and have had a seizure, but everything is all right.
If a friend or family member is in the reception area, allow them to talk with the patient - they will respond more quickly to a familiar voice.
- ABC (airway/breathing/circulation) as needed
- Airway - if snoring; Breathing & Circulation usually not necessary.
- Position: - Turn patient on side, if possible - aids in airway maintenance.
- Dental Chair: Maintain supine, maintain airway prn.
- EMS will determine disposition of patient following seizure.
- Hospitalization if not oriented in space & time
- Discharge to home, if oriented to space & time, and if in company of companion
Medications for Seizures:
Midazolam 2 mg/ml.
Adults: 4 mg IV, given slowly, 2 mg/ml, may repeat q10-15 minutes,
Pedo: 0.05 – 0.1 mg /kg, max 4 mg/dose
Note: Only professionals specifically trained in managing apneic patients should administer anticonvulsants. EMS personnel are trained to administer these drugs.