Blog #38: Football Coach Has Convulsion on the Field. What Happens Next?

(This blog was originally posted on September 18, 2013)

 

University of Minnesota football coach, Jerry Kill, recently had a convulsion on the field. Known to have chronic epilepsy, he was transported to a local hospital. If a person with epilepsy has a convulsion, what happens next?

            If the seizure occurs at home in the presence of family who are experienced with their loved one’s epilepsy history, the person is protected from harm and just observed. The seizure is self-limited and after a minute or two, the patient sleeps. Upon awakening in minutes to hours, the patient resumes normal activities.

 If the convulsion occurs outside the home, the patient generally is brought to a hospital emergency room. Convulsions usually end by themselves in one or two minutes and then require very little first aid. But, if the convulsion continues in the emergency room, the medical staff will ensure that an open airway is provided with appropriate head positioning. They will insert a plastic piece that fits in the mouth to keep the tongue from obstructing the throat passage. A simple oximeter is attached to a finger to determine if adequate oxygen is entering the body. Vital signs (blood pressure, heart rhythm and temperature) are monitored. An intravenous line is started to ensure that anticonvulsant and other medications can be administered if necessary. Blood will be drawn to test for possible serious medical conditions. Restraints on limbs aren’t used. These can cause fractures or dislocate flailing limbs.

Information from a patient’s medic-alert bracelet/necklace, wallet or from relatives/friends can help the medical staff make a faster diagnosis if they are available.

            In most cases, by the time the ambulance or private car arrives at the hospital, the convulsion has ended; the person will be in a post-ictal state and appear confused. In this situation, no extreme first aid measures are required. The patient is evaluated as he regains alertness. When the staff learns that the patient is known to have epilepsy, and is on anticonvulsant medications, the patient is discharged home as soon as he is alert, which generally is after an hour or two. The patient is advised to consult with his physician or neurologist to evaluate any need for change in medication(s) and, or dosages, in order to gain better seizure control, if possible. Brain scans and EEGs usually have been done in the past and are not repeated unless a change in the patient’s condition is found.

            Best advice: Take prescribed medications correctly; don’t drive if seizures aren’t controlled; don’t bathe/shower unless the bathroom door is open and someone is at home AT ALL TIMES, if possible (I know of 12 drownings at home—5 fell face-down blocking the shower drain); obtain medic-alert bracelet/necklace that reflects diagnosis and medications; wear helmets when biking; get adequate sleep and minimize alcohol intake.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.