Search for tag: "seizure"

Interviewer: What should you do if somebody faints? We'll examine that next on The Scope.

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Interviewer: All right. Here's the situation. You're in a social situation, maybe you're at home, maybe you're out and about, and somebody faints, like the traditional they're standing and the next minute they're down on the ground. What should you do? Dr. Troy Madsen is an emergency room physician at University of Utah Health. What should I do?

Dr. Madsen: Well, that's a great question, because fainting can be a really scary thing when you see it happen, and I'm speaking from personal experience here, not just as a physician. But, you know, it wasn't too long ago I was traveling with my wife. We were out eating lunch, and she looked over at me and my face just went blank. The next thing she knows my face falls down, I fall forward, knocked my water over. I'm lying on the table, and she's calling for help. She didn't know what had happened. This is me.

Interviewer: You were the fainter.

Dr. Madsen: I was the fainter.

Interviewer: Wow.

Dr. Madsen: Exactly.

Interviewer: Did you feel it coming on?

Dr. Madsen: I did. I felt it coming on, but then it just came on, and then after that I didn't remember anything. So she lifts me up off the table, and then she says my arm just went up like a bird and started shaking. She thought I was having a seizure. It was pretty dramatic. Finally, they got help there. They called 911, you know, all this drama that I really did not want to have happen. They ended up sending me to the ER, which I absolutely did not want to go to because I work in an ER. Everything checked out fine.

But it's one of these things where, when you see it happen, it's a pretty dramatic thing. I think the best thing you can do obviously is stay calm. It was great she wanted to lift me up, because she said my face was down in the water on the table. But the reason I started shaking like that is if you lift someone up when they've had, say they fainted, the blood is rushed out of their head, that decreases the blood flow to their head, and then they can have what looks like a seizure, which is what I did.

So the best thing you can really do is just help the person to lie down, get them comfortable. They're usually going to come to within about 30 seconds, and then they're not going to know exactly what happened. Typically, then it's going to take some time, maybe the next 30 minutes before they can really get up and start walking around, because they're typically pretty weak at that point. But it tends to be very dramatic like that was, but generally it's not a sign of anything really serious.

Interviewer: Really? That shocks me a little bit.

Dr. Madsen: Yeah. I know it's a little surprising, but you'd be surprised at how often we see people in the ER who have fainted. And if the person is a younger person who's otherwise healthy, typically we'll get an EKG just to make sure their heart is okay. Maybe blood work, but that's usually not necessary. In females, we always just make sure they're not pregnant. Certainly, if you're pregnant and you have issues with that, that could cause you to pass out. And 99.9% of the time everything is absolutely fine, and we just don't find anything wrong.

You can have what's called vasovagal syncope, syncope meaning passing out. Vasovagal just means that your blood vessels dilate. A lot of things can cause that to happen. If you stand up too quickly, decreases the blood flow to your brain. You pass out. It's your body's response to get you flat and get the blood flow back to your brain.

Interviewer: I'm going to push on this.

Dr. Madsen: Okay.

Interviewer: To me, as the average person, I'm like but something had to cause it that can't be right. Something had to have malfunctioned that should be working better than that.

Dr. Madsen: And that's what we think. I mean, you know, in my mind too there was the side of me that's just the emotional aspect like, "Wow, this was crazy. This really, really scares me." But then there's the rational aspect at that time when I passed out, I'm just saying to myself, "Hey, odds are nothing is wrong."

And I think back that day I hadn't been drinking fluids like I should. I'd been a lot of time on my feet. Actually, we were in Washington, D.C., at the Holocaust Museum, very emotional kind of response. So all of those sorts of things can then contribute to cause that response in the blood vessels where they dilate. That blood flow decreases to the brain, and then that's what causes you to pass out.

Interviewer: So it sounds like that we kind of know generally what causes it, but how that comes about we don't really know?

Dr. Madsen: Well, like I said, I mean it could be a combination of things. It's really a response often to, again, maybe there's a dehydration component, maybe there's an anxiety component.

Interviewer: You're saying a lot of maybes. It sounds like for any individual it could be a lot of different components.

Dr. Madsen: It could.

Interviewer: And we really don't have a lot of predictors?

Dr. Madsen: Yeah. That's true. We don't have a lot of predictors. Sometimes we see people in the ER who have multiple episodes, where they pass out lots of times, and they've had multiple tests done and they just can't figure out exactly what's causing this. So they're prescribed salt tablets, things like that to try and keep fluids in their vessels. You know, prescribing lots of fluid intake, things like that.

And I should qualify this too by saying that if you're someone who's older, who has other medical problems like heart failure, or if you had strokes, any kidney problems, things like that, then we probably need to do more testing. And those are the cases where I do get more concern, say someone who's 65 who's had heart problems, we're going to do a lot more tests. We're going to keep him in the ER, probably overnight in the hospital, do an ultrasound of their heart, looking for other possible causes.

Interviewer: But otherwise, healthy individuals, 99.9% of the time it's not.

Dr. Madsen: That's exactly right.

Interviewer: No real reason to go to the ER?

Dr. Madsen: Yeah.

Interviewer: Okay.

Dr. Madsen: And if I had to say, you know, it's 99.9%, one of a thousand cases maybe I've seen someone comes in and then we find something on their EKG, or we see some sort of crazy heart rhythm that they go into, and it's like, "Wow, there's our answer." But the large majority of the time, these things happen and we don't find anything really wrong.

Interviewer: So all in all, fainting not as dramatic as one would think.

Dr. Madsen: That's right. It tends to be very dramatic, like I said, like my experience was a whole lot more drama than I had ever wanted on that trip, but usually things turn out fine.

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Dr. Troy Madsen: So, let's say you're sitting at work and the person next to you falls to the ground and starts shaking over their entire body. They're having a seizure, what do you do? I'm Dr. Troy Madsen, emergency physician at the University of Utah hospital and that's next on The Scope.

Man: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Troy Madsen: So, you're sitting next to someone, and this is something I've actually seen in the ER. So, you're at a play, Pioneer Theater, it's a great play, and then the person next to you just starts to shake. At first, you're trying not to pay attention, like "I'm not quite sure what they're doing". The big question you ask yourself first is "Is this a seizure"?
Typically, if someone is shaking all over their body and they are not responding to you, that is a seizure. There may be cases where people have abnormal seizures. You may have heard of people just staring off into space. If you have kids maybe sometimes you've wondered if they're having a seizure. They just stare off and they don't respond to you.
Other seizures where just one part of a person's body will shake, maybe their arm or leg. So, kind of some unusual seizures, but the classic thing we see is someone shaking all over their body.
So, the big question too, is then, what is it that really causes a seizure? Really, a seizure is abnormal electrical activity in the brain. You could just think of the electricity going haywire, just kind of going all over the place in the brain.
We'll do things called EEGs on these patients where we actually put electrodes on their head to measure the electrical activity. You look at these EEGs and you're just seeing this electrical activity all over the place, just much different than what we see in a normal person. So, that's what's causing a seizure.
It's always hard to say exactly what part of the brain may have sparked that or what may have caused it. It's interesting; I find that people that come in the ER with seizures, for a lot of them it's the first time they've had a seizure. For most of them, they'll never have another seizure in their life.
I may not know exactly what caused it, we'll do tests to try and figure it out, but sometimes it just happens. Just because you've had one seizure, doesn't mean you're going to have epilepsy, or have seizures for the rest of your life requiring medication.
Again, back to that situation, you're sitting next to this person, they're having a seizure. You look over and they're shaking all over, they're not responding to you or anyone else. What do you do?
Well, the first thing is to get help because this is someone who needs to get an ambulance there. They may need an IV to give them medication to stop the seizure and then get them to the ER to get additional treatment for the seizure and additional testing.
So, in terms of what you're going to do right there, you may think "Okay, I've called for help, but I'm concerned this person is going to bite their tongue." You may have heard at some point "Well, I've got to put a wallet in their mouth". Some people have even said that they were at a restaurant and they actually saw someone put a spoon in someone's mouth to keep them from swallowing their tongue.
The biggest thing I'd tell you here is "Don't do it!" Don't put anything in their mouth because that could just make things worse. Now, this is someone who is not aware of what's in their mouth, something could easily slip out, go down their airway, and block if off.
The good news is with most seizures, they're going to stop in less than five minutes. It's very rare that a seizure goes on beyond that. As long as you can keep this person safe, you don't need to put something in their mouth, just kind of help them so they are not hitting their head violently against the ground or against a chair or something like that.
Just help them so that they're safe so they're not going to hurt themselves further with the seizure. Like I said, it's generally going to stop fairly soon. At that point, the person is often times going to be really sleepy, they may not respond to you. It may take ten to fifteen minutes for them even to respond.
They'll have no idea what happened. They don't know, oftentimes, where they are or what happened what they were doing and that's all part of the seizure and it's something we expect.
So, keep in mind, if you're in a situation where someone has a seizure, less is more. The less you do, the better. Keep them safe, get help there, don't feel like you have to do a whole lot besides that and once you get them the help they need, they're in good hands.

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