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Managing Adult Medical Emergencies in the Dental Office
Seizures

Course Author(s): Palma A. Freydinger, DDS;Fady F. Faddoul, DDS, MSD

Seizures

Seizures are a group of neurological disorders caused by excessive discharge of cerebral neurons. They may lead to focal (motor, sensory (somatic, visual, auditory, olfactory); psychomotor (automatisms, psychical); or generalized (myoclonic, absence, and tonic-clonic or grand mal (Table 12) seizures. The cause may be genetic; or head trauma, hypoxia, infection (fever) pregnancy, drug or alcohol overdose or withdrawal, sensory input (e.g., sound, light, touch, and smell), hypoglycemia, circulatory disturbances, degenerative disorders, and tumors.

Table 12. Tonic-clinic (grand mal) Seizure.

Prevention:
  • Identify at-risk patient
    • Eliminate known causative or precipitating factors (if possible)
    • Confirm compliance with anticonvulsant chemotherapy
    • Reduce anxiety
    • Ensure profound local anesthesia
      • Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity
Signs and symptoms:
  • Aura phase
    • Visual and auditory disturbances
    • Dizziness
  • Sudden loss of consciousness
    • Initial convulsions explosively force air out of the lungs, resulting in the epileptic “cry”
    • Generalized motor tonic-clonic seizures follow this eerie, birdlike scream
      • The tonic component is characterized by opisthotonos, the person is forced into an arched position when the violent spasm of all body musculature pulls his back muscles
        • Arching of the back causes convexity in the ventral body region
      • The clonic component is characterized by alternating contraction and relaxation of all muscles
    • Tongue-biting
    • Increased salivation
    • Incontinence
    • Hyperventilation
  • Postictal depression of motor and sensory function
    • Fatigue, mental confusion, and respiratory depression
Emergency response:
  • Place patient in a supine position
    • Protect patient from injury
      • Guide the extremities during seizure, but do not restrain
    • After the seizure is complete
      • Suction oral cavity if needed
      • Position patient on his/her side (recovery position)
      • Administer oxygen
        • 4 to 6 L/minute by nasal cannula
      • Monitor vital signs
        • If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest
          • Activate EMS
            • Immediate CPR and defibrillation congruent with current recommendations
Nota bene:
  • Signs of recovery: patient regains consciousness, respiration returns to normal
  • Signs of deterioration: unconsciousness persists, respiratory depression progressing to respiratory arrest
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