Seizure in the clinic: first aid

A seizure is one of the events least expected in an orofacial harmonization (HOF) clinic and one of the most frightening for anyone who has never seen one. The scene is striking: the patient loses consciousness, the body stiffens or thrashes, the breathing pattern changes, and the team has seconds to decide what to do. The good news is that the initial response is simple, and anyone who knows the script acts more calmly.

This page covers the initial response at the level of first aid and clinic organization. It includes no medications or doses: medical management, when needed, is led by the emergency service and a qualified professional, following current protocols. SAMU 192 is Brazil's emergency medical service.

Why prepare the team beforehand?

The first seizure the team witnesses should not be the first time anyone thinks about it. In general, what hurts most in the moment is panic: too many people around, attempts to restrain, an object in the mouth, no timing. A short script, practiced in an emergency drill with the team, reduces these mistakes and improves the record.

Preparation also starts at the consultation. A well-done medical history in HOF asks about epilepsy, previous seizures, fainting, diabetes, medication use, and withdrawal from alcohol or substances. Anyone with a history calls for a specific plan, as described in epilepsy and HOF procedures.

What should you do during the seizure?

One person should be in charge of leading, another of timing and calling the emergency service, and a third of keeping onlookers away and clearing the space.

When should you call SAMU (192)?

The decision to call should be quick and, if in doubt, in favor of calling. In general, the signs that the patient needs emergency care include:

More details on when and how to call are in when to call SAMU and hospital transfer of the patient. Even when the seizure ends on its own and the patient seems well, the decision to discharge without assessment rests with the qualified practitioner, with guidance to a companion and referral for investigation.

What could the causes be?

Not every seizure is epilepsy, and identifying the likely cause helps guide referral. The most common situations to consider:

• Prior epilepsy, with or without regular medication.
• Syncope with jerking movements: fainting, especially vasovagal, can cause brief jerks and be mistaken for a seizure. See vasovagal syncope in the clinic and syncope or anaphylaxis.
• Hypoglycemia, especially in a patient who has fasted for a long time or has diabetes.
• Systemic local anesthetic toxicity, rare, with early signs such as tingling around the mouth, a metallic taste, and ringing in the ears. See systemic local anesthetic toxicity.
• Withdrawal or intoxication from alcohol and other substances.
• Acute neurological causes, such as stroke (see suspected stroke in the clinic).

The team does not need to settle on a diagnosis: it needs to stabilize, observe, communicate, and refer.

What should you do after the seizure ends?

Many patients are confused, drowsy, and disoriented after a seizure, which is expected but calls for observation. In this phase:

1. keep the patient lying on their side, in a calm environment, without crowding;
2. speak calmly, explain where they are and what happened, without rushing for answers;
3. continuously check breathing, skin color, and level of consciousness;
4. look for injuries (tongue, head, mouth, shoulders);
5. do not offer food or liquids until consciousness has fully returned;
6. have a companion present and record the emergency contact.

How do you record and communicate?

The record is part of the response. In the patient record, note the start and end times, what was observed, what was done, who was present, when the emergency service was called, and how the patient left. Keep photos only if there is clinical need and authorization, and respect confidentiality. See recording the emergency in the clinic, patient record and documentation in HOF, and clinic complication SOP.

Talk to the patient and the companion honestly, without speculating about causes and without minimizing. For the conversation after the event, see telling the patient about a complication.

How do you prepare the clinic?

• Keep the treatment space free of objects that could cause injury in a fall.
• Make sure the table or chair lets you lay the patient down easily.
• Keep the phone number for SAMU 192 and the reference hospital in view.
• Have a clock or timer visible, to mark the duration.
• Review the HOF clinic emergency kit and the team's basic life support training.

A seizure in the clinic is rare, but preparation is cheap: a script, a drill, and a well-kept record. Harmy does not take part in the clinical response, which always belongs to the qualified practitioner and the emergency services.