The question of whether to perform Cardiopulmonary Resuscitation (CPR) on someone experiencing a seizure requires sequential, practical guidance. Seizures are common, but the need for CPR is an infrequent, though life-threatening, complication.
CPR is not the immediate first aid response, but it becomes necessary only under specific conditions after the seizure activity has ended. Understanding the correct steps and timing is crucial for safely managing the situation and potentially saving a life.
Immediate Priorities During a Seizure
The initial response when someone is having a seizure, particularly a tonic-clonic type, is to prioritize their protection from injury, not resuscitation. Do not attempt to physically hold down or restrain the person, as this action will not stop the seizure and can cause musculoskeletal injuries. Instead, the surrounding area should be immediately cleared of any hard, sharp, or potentially hazardous objects that the person might strike during the convulsive phase.
A soft, flat item, such as a folded jacket or pillow, should be gently placed underneath the person’s head to provide cushioning against the floor. Additionally, any constricting clothing around the neck, like a tie or collar, should be loosened to help ease breathing. Seizures typically resolve on their own within a few minutes, so a clock or timer should be used to track the duration of the event.
Assessing the Need for Resuscitation
The transition from seizure first aid to emergency assessment begins once the active, jerky movements have completely stopped. During the seizure, breathing may become shallow or temporarily stop as the chest muscles tighten, but it almost always resumes naturally. CPR should not be attempted during the seizure itself.
Once the seizure is over, the person may be unresponsive, confused, or drowsy, which is known as the postictal state. If the person is unresponsive but breathing, they should be gently rolled onto their side into the recovery position, with the mouth pointed toward the ground. This positioning prevents saliva, vomit, or other fluids from blocking the airway, which is a significant risk in the postictal phase. If the person is unresponsive and not breathing normally, or has no pulse, the decision to initiate CPR must be made immediately.
Performing CPR in an Emergency Seizure Scenario
CPR is only initiated if the breathing and circulation have ceased following the seizure. If the person is unresponsive and not breathing normally, roll them onto their back on a firm surface to begin chest compressions. The standard protocol for adult CPR involves delivering 30 chest compressions followed by two rescue breaths (a 30:2 ratio).
Compressions must be performed hard and fast, pushing down at least two inches deep on the center of the chest, at a rate of 100 to 120 compressions per minute. Before delivering rescue breaths, the airway must be checked and cleared, as post-seizure patients may have saliva or vomit present. Continue the 30:2 cycle without interruption until medical professionals arrive or the person shows clear signs of recovery.