CONVULSIONS/FITTING

PROTOCOL # 12

PRESENTED BY
Jawad Ahmed
 FITTING/CONVULSIONS

 Fitts/convulsions means “contractions of the muscles”

 An Abnormal Firing of brain cells,usually resulting in

twitching movements.also known as convulsions,epilepsy
or seizurez(sudden attack)
HOW DOES OUR NERVOUS SYSTEM WORK?

As the diagram shows,

nerves throughout the
body act like telephone
lines, allowing the brain
to communicate with the
rest of the body via
signals
 NORMAL FIRING OF BRAIN

• In a normal brain, there

are millions of specialized
nerve cells, called neurons,
that transmit electrical
impulses. These impulses
communicate with other
areas of the brain and
serve in the everyday
functions.
 ABNORMAL FIRING OF BRAIN CELLS

• when the normal electrical

balance in the brain is lost.
The brain's nerve cells misfire

• They either fire when they

shouldn't or don't fire when they
should.

• The result is a sudden brief,

uncontrolled burst of abnormal
electrical activity in the brain

• When these impulses misfire,

seizure occurs.
 CAUSES OF CONVULSIONS/FITTING

• Cardiac arrest
• Diabetes
• Drug
• Eclampsia
• Epilepsy(unknown)
• Fever(In children)
• Hypoxia(inadequate oxygen)
• Meningitus(Infection around the brain)
 KEY QUESTIONS
Q1.Has s/he had more than one fit in a row?
CONTINUOUS FITTING
A fit in an unconscious patient that is still in progress at the
end of the interrogation and after a physical verification by the
caller.(EMD must stay on the line to check)

MULTIPLE FITTING
The occurance of more than one fit in a patient who
remains unconscious or not alert between episodes

Focal FITTING

Localised twitching the part of the body such as the

hand,arm,leg,or face,in a concious patient.m
 KEY QUESTIONS

Q2.Female(12-50) is she pregnanat?

Q3.Is s/he diabetic?

C 1 FOCAL fit (not alert) 12-c-1

2 Pregnancy 12-c-2

3 Diabetic 12-c-3
 KEY QUESTIONS
Q4 Is s/he an epileptic or ever had a fit before?

EPILEPSY

IT is a common chronic neurological disorder characterized by seizures .

It is a disorder of the nervous system

RECURRENT FITTING

Epileptics may have more than one fit in a day.these are considered as a
recurrent fits if the patient is able to regain consciousness between
episodes.
FEBRILE FIT

Febrile fits occurs in 3 to 5 % of all children between 6 months and 5

years of age as the result of fever
 KEY QUESTIONS
Q5. (NON FOCAL)has the twittching stopped yet?
(NO)................................................................................... 12D2
a. (YES) Okay is s/he breathing at the moment?
(Go and check and tell me what you find)..........................?

Q6.(FOCAL) Is s/he completely Alert(responding Appropriately)

a. (NO) Okay is s/he breathing at the moment?
(Go and check and tell me what you
find)...........................?

? (Breathing) okay, I want you to tell me every

time s/he takes a breath, starting
now

. >10 sec interval=agonal/ineffective

 TYPES OF FITTING

Absence (petit -mal) fitts

Petit mal is French word means "little illness“.

Atonic (drop attacks)

Atonic means "without tone"

Myoclonic Seizures(brief bilateral twitches)

Myo" means muscle and "clonic" means rapidly twitching

of a muscle.

Tonic-clonic Seizures
video
 DETERMINANAT DESCRIPTION
LEVELS # DETERMINANAT DESCRIPTION E CODES

D 1 Not breathing(after key question) 12-D-1

2 CONTINUOUS OR MULTIPLE fitting 12-D-2
3 AGONAL/INEFFECTING BREATHING 12-D-3
4 Effective breathing not verified > 35 12-D-4

C 1 FOCAL fit (not alert) 12-C-1

2 Pregnancy 12-C-2
3 Diabetic 12-C-3

B 1 Effective breathing not verified<35 12-B-1

A 1 Not fitting now and breathing effectively(verified) 12-A-1

2 focal fit (alert) 12-A- 2
3 impending fit (aura) 12-A- 3
 RULES
• A fit in a person ≥ 35 is considered a cardiac arrest until
effective breathing is physically verified by the caller.

• Check ABCs very carefully before initiating CPR after a fit.

• When the initial Chief Complaint appears to be fitting, go to

Protocol 12 regardless of consciousness and breathing status.

• Do not attempt to reduce fever in febrile fitting patient.

 Axioms
• Fitting-like activity can be initial symptom of cardiac arrest.

• All actively fitting patients appear to have abnormal or absent

breathing.

• A fitting patient with an unknown history of fits has most likely had
fits before

• Tonic-clonic (grand mal) fits generally last about 60 seconds.

• Some patients experience a premonition or sensation (aura) prior

to having a fit. An aura may involve strange sights, sounds, smells,
or tastes. These patients may call for an ambulance before actually
having a fit.
 POST DISPATCH INSTRUCTION
a. I am organizing help for you now
stay online and i will tell you exactly what to do next

b. (not breathing after KQS) go for cpr

c. If s/he is still fitting(or if s/he start a fit again to fit again)

1.don’t do resuscitation.
2.don’t hold her/him down or force anything into her/his mouth
3.move dangerous objects away from her/him
 POST DISPATCH INSTRUCTION

d. When s/he stop fitting (lay her/him down) and make sure s/he
is breathing.

e.Turn her/him gently on her/his side when the fitting stops.

f.When s/he wakes up,reassure her/him and tell her/him not to

get up or walk around

g.(not fitting) if s/he start to fit again,tell me imediately.

Stay on line with caller untill the patient starts to wake up.
 Gender Wise Report
Male Female Children
24%

51%

25%
 LEVEL WISE REPORT

350 311
300
250
200
134
150
93
100
40
50
0
DELTA CHARLIE BRAVO ALPHA ALPHA
 STATION WISE REPORT
120 103 99
100
80 63 76
67
60
53 55
40
20
22 28
0
r 12
ali im gi
M as
an rg h i
Q o r l b e
ac az E n
Bi
n K Gu Ka
r N SIT o i a
rth i ft la d CH
S
rth
No Cl B E
N o P
 ORIGIN WISE REPORT
450
401
400
350
300
250
200
152
150
100
50 23
0 1 1
0
 EXPERIENCE

 EC NO:115413  EC NO 115302  EC NO 79798

DATE: 7th march 2011 DATE: 7th march 2011 DATE:26thOCT2010
TIME: 12:25 TIME:6:02 TIME:9:06
GENDER:MALE GENDER:FEMALE GENDER:MALE
AGE:60 YEARS AGE:42 YEARS AGE:55YEARS
CODE:12D2 CODE: 12D2 CODE: 12D2
FROM :LANDHI FROM:FJC FROM :LANDHI
TO:JPMC TO:SIUT TO:SIUT
EMD:NASIRA EMD:HERALD EMD:SADIA
RES: 9 MIN RES: 10 MIN RES: 13 MIN
 SEIZURES FACTS

 Seizures is not a reason of death

As we have two death records

1.EC: 84805 DATE: 13TH NOV 2010
AGE:2 YEARS GENDER:CHILD

2.EC: 97718 DATE: 04TH JAN 2011

AGE:65YEARS GENDER: FEMALE
 SEIZURES FACTS

 200,000 new cases of epilepsy are diagnosed each year.

 Incidence is highest under the age of 2 and over 65.

 45,000 children under the age of 15 develop epilepsy each year.

 Males are slightly more likely to develop epilepsy than females.

 In a series of more than 2000 cases found that 57% of them were
male and 43% were females.