Non Breathing Convulsion- Why?

[mysticlakecasinoemt]

Worked BLS for a sci fi convention. Had a 27 year old male known diabetic drop into a seizure right in front of us. Combative, then non responsive to pain, cyanotic a minute after and non breathing. Had to help on an ambu bag for two minutes. O2 sats lowest was 80% for a quarter of a minute, head, neck and shoulder cyanosis until the convulsion relaxed. Went from purple to pink after three bag vents room air and later regained spontaneous respirations two minutes after support began. Hx.. no food since the night before. (It was 10 am the next day), insulin dependent diabetic, no sleep for three days. Vitals were : Pulse 126 bounding, regular , skin warm, dry, red. Couldn't tell pupil comparison, one eye was glass. The one was pinpricked, non reactive, then dilated, until good color was regained. Some mouth blood, drained out easily with tipping from a bitten tongue and lip. Chest was clear post blood suctioning and BP was 200 palpated. Cops came with oxygen and sats returned to high 90's post venting. No ETOH on board, no other history past diabetic related seizure a year and a half earlier requiring hospitalization. Medalert tag said diabetes and dilantin.

Didn't get the blood glucose from the medics, nor a new pressure when patient awoke to a glasgow of twelve but with inappropriate verbal responses, acting postictal and somewhat confused. He shipped out too fast for note comparisons. I am a BLS level EMT-Basic.

What caused such a profound nonbreathing effect with this convulsion? Any ideas, care advice for future incidences like this one?

[Ridryder 911]

Sounds like typical seizure activity. The brain has to "restart" the sensory again. Probably the patient might had actually some respiratory drive although very hypoventillatory in nature. It is common to see this in post-ictal phase of seizures and as well in diabetics. Since the seizures was probably glucose related, it might be related to it as well. Usually, in the early phase of post seizures patients may have very deep ..slow respiratory drive, possibly secondary from the anoxia during the seizures.

Sounds like the patient has a very outstanding medical history and complications.

Be safe,

R/R 911

[hammerpcp]

Was the pt still seizing while he was not breathing? Perhaps in the tonic stage of seizure? If so that is perfectly normal. Since the brain is sending out random unorganized signals, the respiratory muscles do not function properly. A seizure is basically fibrillation of the brain. Are you sure pt had no seizure Hx? I have never seen anticonvulsive drugs prescribed for hypoglycemic seizures. I think the goal in that case is to control the blood glucose more effectively.

[ERDoc]

While the seizure does sound like a typical seizure, I'm having trouble saying it is glucose related. It sounds to me like he has diabetes and a seizure disorder. People don't take dilantin for glucose related seizures. He also stopped seizing without intervention. A metabolic derangement that causes a seizure will generally continue to have a seizure until the derangement is corrected (although this is not 100% of the time).

[hammerpcp]

I forgot to say: Or what Rid said. The post ictal stage is caused by insufficient neurotransmitters. The seizure just used them all up, so while the brain is 'resetting' it is actually replenishing its neurotransmitters. Clear as mud? lol

[mysticlakecasinoemt]

Was the pt still seizing while he was not breathing? Are you sure pt had no seizure Hx? I think the goal in that case is to control the blood glucose more effectively.

The seizure had ended. He was not breathing for two minutes post. O2 sats during this time rose from 80 to 97% on ambu vents room air. He had a history of seizures, from a year and a half ago. I thought airway management was the priority. He was blue. The care hints I'm looking for is for the EMT-Basic's level. But thanks for your input about glucose level concerns. I wasn't given any hints as to what they were. He was a definite load and go.

Another sign, was incontinence.

[hammerpcp]

Then it's a pretty good bet he wasn't faking at least. Code brown alert!

[nsmedic393]

While the seizure does sound like a typical seizure, I'm having trouble saying it is glucose related. It sounds to me like he has diabetes and a seizure disorder. People don't take dilantin for glucose related seizures. He also stopped seizing without intervention. A metabolic derangement that causes a seizure will generally continue to have a seizure until the derangement is corrected (although this is not 100% of the time).

I agree 100%. The first thing I thought when seeing what was on his medic alert tag was that he probably had two seperate conditions.

Without a glucometer or pharmacological interventions, and especially since he was obviously hypoxic airway is obviously your highest priority. Sounds like you did what you needed to do. Good job.

[Dustdevil]

Then it's a pretty good bet he wasn't faking at least. Code brown alert!

I dunno. Remember, we're talking about Sci Fi geeks. Sounds like pretty typical behaviour to me.