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If convulsion is recurrent or ongoing:

Assess ABCs:

 adjunctive airway if necessary

 oxygen supplementation

Protect patient from harm:

 protect head

 move away from hard objects

Rapid glucose determination or dextrose administration

Benzodiazepine administration IM or IV (intravenous access)

Hypoglycemia is common and may cause seizures. Perform rapid glucose determination if possible; consider dextrose administration in diabetics or if hypoglycemia is suspected or confirmed. In some systems thiamine is available and should be administered if the possibility of malnutrition is present.

History should be obtained, if possible. Key factors include a history of epilepsy, current medications, substance abuse, medical conditions, or trauma. A description of the event should be obtained from witnesses, including a description of any prodromal symptoms. Physical examination includes a survey for injury. Some physical examination findings suggest seizures. Tongue biting on the lateral portion of the tongue suggests convulsions, although absence of tongue biting has no diagnostic value [31]. Incontinence suggests a generalized seizure.

If the patient is still having generalized convulsions at the time of EMS arrival, status epilepticus may be presumed to be present, again unless the response interval is very short [30, 32]. Seizure duration of greater than 5 minutes or recurrent seizures without regaining consciousness between convulsions is the modern definition of status epilepticus. Initial stabilization steps and preparation for medication administration should proceed (Box 17.5).