Prehospital Emergency Care Chapter 19 Seizures and Syncope

1) You are summoned to a grocery store for an elderly female patient found having a "fit" by store employees. Upon arrival, you are escorted to the side of an alert but mildly confused 81year-old woman who is diaphoretic and appears exhausted. After 2-3 more minutes, she becomes more alert and informs you that she has a history of seizures and just had a generalized seizure. Despite your urging, she refuses transport to the hospital because "that's where people go to die." Your safest action would be to:

A) Transport the patient despite her refusal to consent.

B) Advise medical direction of the situation.

C) Contact law enforcement so your transport of the patient is legal.

D) Recognize a seizure history and have patient sign a refusal form.

Answer: B

2) You have been called for a seizure emergency. On scene, you find an adult female patient actively seizing with bystanders attempting to restrain her. You should:

A) Place a padded tongue blade into the patient's mouth and then instruct the bystanders to release her.

B) Loosen any restrictive clothing the patient is wearing, and then summon ALS backup.

C) Instruct the bystanders to release the patient while you protect her head with your hands.

D) Have bystanders continue restraining the patient while you complete the primary assessment.

Answer: C

3) While you are providing free blood pressure readings at a community health fair, you are taking the blood pressure of a mother of two young twin boys. One of the boys tells you that his twin brother suffers from seizures and asks what he can do if he sees his brother convulsing. Your response would be:

A) "Move any movable objects and furniture away from him."

B) "Hold him securely to the floor until he stops seizing or the EMTs arrive."

C) "Insert a spoon into his mouth to keep him from swallowing his tongue."

D) "Tell your parents immediately, and then try to hold him as still as possible until the ambulance arrives."

Answer: A

4) As a general rule, a postictal patient should be placed on the stretcher and transported in which position?

A) Supine

B) Semi-Fowler's

C) Lateral recumbent

D) Prone

Answer: C

5) After a lengthy response time in a rural community, you arrive at the home of a 62-year-old female patient who is still seizing. Of the listed options, your immediate action would be to:

A) Assess the patient's airway and breathing.

B) Determine if the patient has a seizure history.

C) Determine the total duration of the seizure.

D) Move the patient to the ambulance for assessment and initiate transport.

Answer: A

6) You find a patient, who seized for approximately 2 minutes, supine on the kitchen floor. He responds to painful stimuli and has snoring respirations. Emergency Medical Responders are providing spine motion restriction precautions, and they report the patient's heart rate is 124 beats/min and his pulse oximetry is 89% on room air. The patient has cool and clammy skin. What should you do first?

A) Suction the airway

B) Perform a jaw-thrust maneuver

C) Provide supplemental oxygen

D) Initiate positive pressure ventilation

Answer: B

7) A postictal patient is awake and can communicate with you, but has trouble answering your questions correctly. Given this presentation, the Emergency Medical Technician would recognize that:

A) The airway is open.

B) Another seizure is coming.

C) The patient has a seizure history.

D) High-concentration oxygen is indicated.

Answer: A

8) You are preparing to transport a 46-year-old male patient who has had multiple seizures throughout the morning, according to the family. Currently, he is on your stretcher and is postictal. He has a history of seizures for which he takes anticonvulsant medications. He also has diabetes and kidney failure. Of the equipment listed here, which is the most essential to have ready during transport of this patient?

A) Spine motion restriction equipment

B) Automated external defibrillator

C) Oral glucose

D) Suction device

Answer: D

9) When obtaining a medical history from the family of a patient experiencing seizure, which of these questions is most important for the Emergency Medical Technician to ask first (select best answer)?

A) "How long has he had his seizure condition?"

B) "Has he ever been hospitalized for seizures?"

C) "Does he take his seizure medications as prescribed?"

D) "Was he grunting and breathing hard during the seizure?"

Answer: C

10) While you are placing a 52-year-old female patient, whose complaint is a headache, on the stretcher, she begins to seize. Your immediate action would be to:

A) Quickly move her to the ambulance for rapid transport.

B) Perform a jaw-thrust maneuver and insert an oropharyngeal airway.

C) Raise the side rails and do not apply the straps very tightly.

D) Remove the patient from the stretcher and place her on the ground.

Answer: C

11) How would you transport a patient experiencing a seizure who is strongly suspected of having a cervical spine cord injury?

A) Supine on the stretcher with straps loosely applied

B) In lateral recumbent position with a cervical collar in place

C) With spine motion restriction precautions applied and a cervical collar in place

D) In semi-sitting position with a cervical collar in place

Answer: C

12) You are called to a residence to assess a child. The panicked parents state that their 3-yearold son was playing with his brother when he suddenly "blanked out" and would not respond to them for several seconds. When asked, they deny any convulsing-type movement as well as a history of medical problems. Based on this description, you would be suspicious that the patient experienced which type of seizure?

A) Febrile

B) Simple partial

C) Grand mal

D) Absence

Answer: D

13) When performing the secondary assessment on a confused patient who was reportedly unresponsive just prior to your arrival, which of these findings would be most suggestive of a seizure?

A) Bruises to the arms

B) Bleeding tongue

C) Pinpoint pupils

D) Warm skin

Answer: B

14) When an Emergency Medical Technician performs the secondary assessment on a postictal patient with a known history of seizures, which of these assessment findings would be of most concern?

A) Confused mental status

B) Heart rate of 116 beats/min

C) Loss of bladder control

D) New contusion noted to the forehead

Answer: D

15) You are caring for a postictal male patient with a known history of seizures. He is confused and cannot remember his 8-year-old son's name. His son tearfully asks you if his father will ever remember him. Your response would be:

A) "I do not know. We will have to let the doctor help him first."

B) "I am not sure, but at least your mother remembers your name."

C) "Although he is confused now, he should remember your name in a little bit."

D) "I do not feel comfortable in telling you yes, since there is a chance he may not."

Answer: C

16) You have been called to a public bus station for a behavioral emergency. On scene, you find a disheveled male in his forties sitting up against a wall. He is confused and incontinent. Bystanders state that he was just sitting on a bench watching people walk by, when suddenly he got up and began to stumble around, shouting obscenities, and then fell to the ground with his whole body shaking. From this description, the Emergency Medical Technician should be suspicious of which condition?

A) Generalized seizure

B) Alcohol intoxication

C) Absence seizure

D) Syncopal episode

Answer: A

17) As you approach a female patient, she appears unresponsive, with her arms and legs jerking violently. On the prehospital care report, you would document that the patient was found in which phase of a generalized seizure?

A) Tonic

B) Absence

C) Syncopal

D) Clonic

Answer: D

18) A female patient with a history of seizures has experienced a seizure in a public area and is now refusing further assessment and transport. As you leave, a witness to the entire event tells you that he thinks the patient is "crazy in the head" because immediately before she seized, she looked up toward the ceiling and kept repeating, "Do you see the birds?" As a knowledgeable Emergency Medical Technician, you should recognize that the bystander is describing which condition?

A) Postictal confusion

B) Side effects of seizure medications

C) An aura

D) Syncopal episode

Answer: C

20) The initial phase of a generalized seizure experienced by some patients, in which they may experience an odd smell or something auditory, is called the:

A) Syncopal stage.

B) Aura.

C) Clonic phase.

D) Postictal state.

Answer: B

19) Friends of a male patient who experienced a generalized seizure while at a picnic are worried because he cannot remember the seizure. You should inform them that this is:

A) A concern, because most people can remember the seizure.

B) A normal finding that is common among those who suffer this type of seizure.

C) An important piece of information that warrants immediate transport of the patient to the hospital.

D) Unrelated to the seizure and may indicate a more serious medical problem.

Answer: B

21) Status epilepticus is best differentiated from a generalized seizure by the:

A) Duration of the seizure.

B) Length of the postictal period.

C) Presence of an aura prior to seizing.

D) Preexisting seizure history.

Answer: A

22) The Emergency Medical Technician shows that she understands the danger posed by status epilepticus when she states:

A) "Status epilepticus is an extremely dangerous condition because the patient can go into shock from blood loss."

B) "If the patient does not have a history of seizures, he is at greater risk for status epilepticus."

C) "The longer the seizure continues, the greater the opportunity for permanent brain damage."

D) "Status epilepticus indicates that the medications a patient is taking have reached toxic levels in the body."

Answer: C

23) Which of these patients is most at risk for problems to the airway and breathing?

A) A 32-year-old male who has stopped taking his seizure medications and experienced a 2minute seizure

B) A 23-year-old female with a history of seizures who has been seizing for 24 minutes

C) An 11-year-old postictal boy with no history of seizures but with developmental delays

D) A 76-year-old female who takes anticonvulsant medications and just began seizing

Answer: B

24) Which of these patients would be classified as having status epilepticus?

A) A 16-year-old male who experienced a partial motor seizure for 7 minutes

B) An 89-year-old male who seized immediately upon getting out of bed

C) A 19-year-old female who briefly seized but has been postictal for 20 minutes

D) A 57-year-old female at a group home who seized during the entire evening movie that was shown in the common living room, according to other group home residents

Answer: D

25) You arrive on scene and find Emergency Medical Responders with a seizing patient. Which of these questions should you ask first?

A) "How long has the patient been seizing?"

B) "What are the patient's vital signs?"

C) "Did the patient lose control of his bladder?"

D) "Do you know which medications the patient is taking?"

Answer: A

26) A patient has been actively seizing for 17 minutes. He is cyanotic with shallow and ineffective respirations. Which immediate care should you provide to this patient?

A) Determine if he has a history of seizures

B) Place him in the lateral recumbent position and apply oxygen

C) Apply the automated external defibrillator

D) Attempt to open the airway and begin positive pressure ventilation

Answer: D

27) While you are transporting a 41-year-old woman who is not feeling well, she begins to seize. She has no history of seizures, and the seizure lasts approximately 90 seconds. After 30 seconds of being postictal and totally unresponsive, the woman suddenly seizes again for the remainder of the 12-minute transport. The Emergency Medical Technician should recognize that the patient is experiencing which emergency condition?

A) Undiagnosed epilepsy

B) Hypoglycemic-induced seizures

C) Status epilepticus

D) Partial-motor seizure

Answer: C

28) While taking an Emergency Medical Technician class, you come across a test question that asks you to define the pathophysiology of a seizure. Which answer would you select?

A) "A seizure occurs when the heart beats irregularly, causing a decreased amount of oxygenrich blood to reach the brain."

B) "All seizures are caused by epilepsy, which describes a problem somewhere in the body."

C) "A seizure condition describes a muscle problem that causes the arms and legs to jerk."

D) "A seizure occurs when there is a massive and uncoordinated electrical discharge in the brain."

Answer: D

29) Which of these patients should be categorized as the highest priority for transport?

A) A child with a history of seizures whose mother calls Emergency Medical Services due to a fever of 102°F

B) A pregnant female with no history of seizures who is seizing

C) A postictal patient who has stopped taking his seizure medication

D) An adolescent patient who states he recalls seizing earlier in the day

Answer: B

30) Which of these statements about seizures is true?

A) Patients who have seizures are at increased risk for stroke.

B) All seizures are caused by some form of brain injury.

C) Seizures may be caused by a variety of medical conditions.

D) If the cause of a seizure is unknown, it is classified as status epilepticus.

Answer: C

31) Which type of seizure occurs in children and is caused by a high core temperature?

A) Idiopathic

B) Hypoglycemic

C) Febrile

D) Eclamptic

Answer: C

32) Which of these statements made by a patient who experienced a syncopal episode should concern the Emergency Medical Technician most?

A) "I seemed to get very warm just before passing out."

B) "My chest felt really funny right before I passed out."

C) "I remember feeling faint right before I passed out."

D) "The doctor told me to get out of bed slowly, but I didn't."

Answer: B

33) A patient who experienced an apparent syncopal episode refuses transport to the hospital. Prior to the patient signing a refusal, which of these statements should you make to the patient?

A) "Syncope may indicate a serious underlying condition, so please follow up with a doctor."

B) "The most common cause of syncope is diabetes, so follow up with your doctor."

C) "People who experience a syncopal episode are not allowed to drive unless they go on medication."

D) "Syncope is not dangerous and affects almost everyone, but it is still important to follow up with your doctor."

Answer: A

34) You have been called for a 57-year-old female patient who has "passed out." As you enter the patient's apartment, you find her supine on the living room floor with a cool washcloth on her forehead. She states that she was standing and talking on the telephone when everything went dark. When she came to, she was on the floor. What should you do next?

A) Immediately sit the patient upright while gathering the SAMPLE history

B) Insert a nasopharyngeal airway and apply supplemental oxygen

C) Move the patient to the ambulance for immediate transport, and call for an ALS intercept

D) Complete the primary assessment, and then obtain vital signs while the patient is supine

Answer: D

35) Which of these statements made by a patient would reinforce your suspicion of syncope?

A) "I think that I may have had a seizure."

B) "Once I hit the floor, I was out for only a few seconds."

C) "I have had a low-grade fever for the past three days."

D) "I was lying on the bed when I passed out."

Answer: B

36) A man comes into your station and tells you that he was just diagnosed by his physician as having multiple syncopal episodes the previous week. More specifically, he asks you to explain why he keeps fainting. Which of these statements would be your best response?

A) "For some reason, there was a temporary decrease in the flow of blood to your brain."

B) "A small clot formed in a blood vessel in your brain, but was quickly broken down by the body."

C) "Your blood sugar most likely dropped very quickly, causing you to faint."

D) "A syncopal episode is a small seizure that runs its course very quickly."

Answer: A

37) You are dispatched to a local mall, where you are met by bystanders who state that the patient was talking to a customer representative when she "passed out." You find an alert and oriented 55-year-old female patient lying supine on the tile floor. The patient tells you that the back of her head is hurting, her neck now hurts, and her arms and legs feel very weak. Which action should you perform first?

A) Open her airway with a jaw-thrust maneuver

B) Obtain a full set of vital signs

C) Take manual cervical spine motion restriction

D) Assess the back of the patient's head for injury

Answer: C

38) Which of these is the best explanation of why a patient who experiences a syncopal episode often regains consciousness after falling?

A) The act of falling causes the heart rate to decrease.

B) The supine position allows better perfusion to the brain.

C) The trauma of falling causes the blood glucose level to increase.

D) The seizure stops once the patient is supine.

Answer: B

39) You are an Emergency Medical Technician who finds an adult male patient on his living room floor after the police department had to force the door open. The scene size-up reveals a very cluttered home that smells of urine. On an end table, you find a container of phenytoin (Dilantin) with the patient's name on it. When you pinch his shoulder, the patient responds by moaning and trying to remove your hand from his neck. Based on this information, which of these conditions would you suspect?

A) Syncope

B) Allergic reaction

C) Behavioral emergency

D) Seizure

Answer: D

40) You are called to a residence for seizure activity. On scene, the patient's daughter tells you that her father, who has diabetes, stated that he suddenly felt dizzy and then fell to the floor. Within a few seconds, he began asking what had happened and why he was on the floor. Based on this description, the Emergency Medical Technician should recognize which condition?

A) Generalized seizure

B) Diabetic reaction

C) Aura of a pending seizure

D) Syncopal episode

Answer: D

41) Which sign or symptom would be most helpful in determining that a patient had a syncopal episode rather than a seizure?

A) The extremities twitched, but only for a few moments.

B) There was no period of confusion after the event.

C) The patient never had a seizure before.

D) The patient complained of headache before the event.

Answer: B

42) You have been called to an alcoholic rehabilitation center for a 56-year-old male patient whose left arm suddenly began to shake uncontrollably. He is alert and oriented, and he is terrified that he cannot stop his arm from moving. Which type of seizure should you suspect?

A) Complex partial

B) Generalized

C) Simple partial

D) Psychomotor

Answer: C

43) You are transporting a patient who has a history of simple partial seizures. During transport, she experiences a simple partial seizure involving her right arm. Her pulse is 92, respirations are 14 breaths/min and adequate, blood pressure is 168/88 mmHg, and SpO2 is 98%. Your primary concern would be:

A) Administering supplemental oxygen via nasal cannula.

B) Loss of bowel or bladder control.

C) Placing the patient's arm tightly in a sling to prevent injury.

D) Progression to a generalized seizure.

Answer: D

44) Which of these statements about seizures is true?

A) Simple partial seizures do not cause an alteration in mental status.

B) The cause of most seizures is easily identified.

C) Generalized seizures always last longer than partial seizures.

D) Complex partial seizures involve both cerebral hemispheres.

Answer: A

45) An 86-year-old male patient has experienced a sudden change in mental status and is repeatedly striking a fist against his leg. When you question him, he does not respond. This presentation is most consistent with which condition?

A) Seizure

B) Dementia

C) Diabetes

D) Delirium

Answer: A

46) A 72-year-old male patient with a history of elevated thyroid function and a brain tumor is experiencing a psychomotor seizure. When you enter the room, he is standing up and walking in a circle. He is awake but does not respond to your questions. Family members state that he has had three similar episodes over the past six months, which his physician diagnosed as complex partial seizures. Vital signs are pulse, 112; respirations, 16 breaths/min; blood pressure, 166/68 mmHg; and SpO2, 98%. Which action would be most appropriate in the care of this patient?

A) Determine if a durable power of attorney exists

B) Restrain the patient and apply high-concentration oxygen

C) Proceed with a nonemergency transport

D) Insert a nasopharyngeal airway to ensure airway patency

Answer: C

47) Which of these medications is most closely associated with a history of seizures?

A) Celexa

B) Prozac

C) Xopenex

D) Depakote

Answer: D

48) A 20-year-old patient is unresponsive with snoring respirations. She is in a public restroom and has no family or friends with her. After addressing the airway, breathing, and circulation, you begin the secondary assessment. Which of these signs most likely indicates the patient experienced a seizure?

A) Snoring respirations

B) Urinary incontinence

C) Altered mental status

D) Constricted pupils

Answer: B

49) The Emergency Medical Technician would recognize that a 49-year-old male patient has experienced a primary seizure when his wife states:

A) "He has never had a seizure before—this is his first seizure."

B) "He had seizures in the past, but they are not sure what causes them."

C) "The doctors said that his seizures come from one spot in his brain."

D) "His arms and legs were jerking and he would not talk to me."

Answer: B

50) A 36-year-old male patient with diabetes and hypertension has experienced a secondary seizure. The patient responds to verbal stimuli with garbled speech, and his airway, breathing, and circulation are intact. Vital signs are pulse, 128; respirations, 20 breaths/min and adequate; blood pressure, 158/96 mmHg; and SpO2, 97% on room air. At this time, it is important that the Emergency Medical Technician:

A) Administer oral glucose as a precautionary measure.

B) Position the patient supine on the stretcher and transport.

C) Check the patient's blood sugar with a glucometer.

D) Administer supplemental oxygen at 2 lpm to maintain the oxygen saturation at its current level.

Answer: C

51) When treating a patient who has had a seizure, the most important aspect of providing care is to:

A) Ensure that the patient does not bite his or her tongue.

B) Identify the type and duration of seizure, as well as any history of seizures.

C) Provide supplemental oxygen during the seizure to ensure adequate oxygenation of the brain.

D) Assess for and manage any life-threatening condition found.

Answer: D

52) Regarding a generalized tonic-clonic seizure, which of these statements is true regarding the different stages?

A) The aura comes before a loss of consciousness.

B) The patient is postictal prior to convulsion activity.

C) A loss of consciousness occurs after the clonic (convulsion) phase.

D) The patient becomes postictal just before the hypertonic phase.

Answer: A

53) You believe that a patient experienced a simple partial seizure. Which of these statements made by the patient would reinforce this suspicion?

A) "I cannot remember anything that happened. I must have passed out."

B) "I think that I may have lost control of my bladder and bit my tongue."

C) "My left arm would not stop shaking. I did not know what was happening."

D) "I remember my arms and legs shaking, and then I can't remember anything else."

Answer: C

54) The Emergency Medical Technician would recognize a simple partial seizure when she observes:

A) Jerky muscular activity of a single extremity.

B) Repetitive actions such as lip smacking or finger rolling.

C) Blank staring that begins and ends abruptly.

D) Abrupt personality changes, including fits of rage.

Answer: A

55) A complex partial (psychomotor) seizure can easily be mistaken for:

A) An asthma exacerbation.

B) A left-sided stroke.

C) An absence (petit mal) seizure.

D) Alcohol intoxication.

Answer: D

56) You have been called for a 71-year-old male patient with seizure activity. When you reach the patient's side, you find him lying motionless on the floor of his bedroom with a family member performing chest compression-only CPR. In this situation, your immediate action would be to:

A) Open the airway and begin positive pressure ventilation.

B) Ask the provider to stop CPR and feel for a carotid pulse.

C) Take over CPR and attach the automated external defibrillator.

D) Continue CPR and call for advanced life support assistance.

Answer: B

57) A young male patient with a seizure history is postictal in his bed. His airway is patent, breathing labored, and radial pulse strong and fast. Vital signs are pulse, 140; respirations, 20 breaths/min; blood pressure, 158/92 mmHg; and SpO2, 96% on room air. At this time, which action would be most appropriate?

A) Provide supplemental oxygen

B) Insert an oropharyngeal airway

C) Start positive pressure ventilation

D) Place the patient in a lateral recumbent position

Answer: D

58) You are on the scene of a patient who just experienced a seizure. The patient is still in the postictal phase and is not fully oriented. Family members state that he has a history of diverticulitis, gastric ulcers, and diabetes. Your partner asks you if you think he should obtain a blood glucose level. Your response should be:

A) "Yes, that is a good idea since he has a history of diabetes."

B) "Yes, because if we don't, the hospital may get angry with us."

C) "No, since the seizure has stopped, it is not from a blood sugar abnormality."

D) "No, because even if the sugar is too high or too low, there is nothing we can do about it."

Answer: A

59) You have been asked to speak to a group of new mothers regarding the emergency treatment of a fever. During your presentation, one of the mothers asks you what the link is between a fever and seizures. Your best response would be:

A) "The higher the child's temperature, the greater the decrease in the seizure threshold becomes."

B) "It is not the specific temperature that is of concern, but the rate at which the body temperature rises."

C) "If the temperature of a child's fever rises slowly over several hours, she is at greater risk for seizures."

D) "For a child to seize when she has a fever, she must also have a history of seizures or a cardiac condition."

Answer: A

60) Select all the statements that apply to pediatric seizures (but no more than three).

A) The magnitude and peak of the fever is most likely the cause of a febrile seizure.

B) They ae most common in children as young as 3 to 6 months.

C) Febrile seizures are considered to be secondary seizures.

D) The rate of climb for the temperature is thought to trigger the seizure in pediatrics.

E) About 10% of all children who have a fever will develop febrile seizures.

Answer: A, B, C

3 multiple choice options

61) An 86-year-old male has experienced a seizure and is now lethargic and confused. His family states that the patient has a history of seizures and was sleeping in bed when the seizure was witnessed by his wife. He remains in bed with an intact airway, adequate breathing, and a rapid radial pulse. You also note him to be incontinent of urine. Appropriate care of this patient would include:

A) Considering oxygen and transport with him positioned on his left side.

B) Securing the patient tightly to the stretcher to prevent injury should he seize again.

C) Inserting an oral airway and starting positive pressure ventilation with supplemental oxygen.

D) Considering supplemental oxygen and securing the patient on a long spine board with a cervical collar placed.

Answer: A