The Active Seizure

There is little to be done during the course of an actual seizure other than to protect the patient from injury. Gentle but firm restraint should be used to prevent falls. If possible, the patient should be turned to one side to reduce the risk of aspiration. It is usually not possible to insert a bite block between the teeth without using considerable force and risking damage to teeth. If a bite block is used, be certain that it cannot be aspirated or swallowed. It is usually not necessary or even possible to ventilate a patient effectively during a seizure, but once the attack subsides, ensure a clear airway. Suction and airway adjuncts should be readily available. There is no indication for intravenous anticonvulsant medications during the course of an uncomplicated seizure. Expectant treatment is best. Seizure activity should be observed to determine if it is focal. Unnecessary sedation at this point will complicate evaluation and result in a prolonged decrease in level of consciousness. Seizures that fail to abate are considered status epilepticus (see below).

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