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elfsThe Epilepsy Foundation of America reviewed scenes from 59 television episodes from "Grey's Anatomy," "House, M.D.," and "Private Practice" and the last five seasons of "ER" in which seizures were portrayed. The conclusion? TV doctors depict first aid practices that are incompetent and dangerous:
(HT to anonymous.)
The study found that inappropriate practices, including holding the person down, trying to stop involuntary movements or putting something in the person's mouth, occurred in 25 cases, nearly 46 percent of the time. First aid management was shown appropriately in 17 seizures, or about 29 percent of the time. Appropriateness of first aid could not be determined in 15 incidents of seizures, or 25 percent.I mean, come on, how hard can this be? If the victim is standing up when the seziure happens, guide him to the floor. Put a pillow or folded-up jacket under the head to keep him from hitting it on the ground and injuring his head, neck, or airway during involuntary movements. If you don't know the victim, dial 911 (or the appropriate code for your country) and clear the area around the victim to keep him and bystanders from interacting.
(HT to anonymous.)
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no subject
Date: 2010-02-23 12:25 am (UTC)The only thing you haven't explained more clearly is the, "Put a belt in the epileptic's mouth to prevent them from biting off their own tongue during a seizure." Now, given that your quoted source puts that in the "inappropriate first aid" category, you are subtly trying to tell us that it's a myth.
Perhaps too subtly.
I'd like you to be explicit about that, Elf. Why is the whole belt-in-mouth-to-prevent-biting-off-tongue idea a myth? It's a very strong myth, after all. So having the reason why it's So Very Wrong will give us, your readers, some ammo in our fight to dispel it.
P.S. &emdash; I knew none of the facts that you stated in this post, I'm sorry to say. I'm glad that I now know better.
no subject
Date: 2010-02-23 12:56 am (UTC)Trying to open a locked jaw can damage the persons jaw. Trying to put something in a mouth that is uncontrolled can result in you losing your fingers (that is no joke). Trying to do all this amongst other flailing appendages can result in damage as well.
Lastly, trying to put something in a seizing victims mouth can actually *cause* them to bite their tongue.
Reason #2: first hand experience. I am an epileptic (from the age of 17). Back in the day when this was still advocated (as late as the late 80's), there were numerous times that he injured his hands trying to do place something in my mouth. It never stopped me from biting my tongue. I end up biting my tongue on the sides (and sometimes doing some serious damage) that lasts days. I've never bitten flesh off.
Note that there are two reasons that this myth has existed. One is that people have believed that one could bite one's tongue off
Two is that people have believe that one could swallow one's tongue unless an appropriate tongue suppressor, such as a belt, were put in place. A person cannot swallow their tongue.
For more information on this is myth, read here:
http://www.epilepsyfoundation.org/about/firstaid/
http://www.epilepsy.org.uk/info/firstaid.html#tonicclonic
no subject
Date: 2010-02-23 02:15 am (UTC)As for everything that you say: Perfect. This is exactly the form of mythbusting I was looking for.
(On a personal note, Omaha, I regularly give my, "public service announcements," about mood disorders to people who spout misconceptions about antidepressants (hint: they're not happy pills) and also, more importantly, who don't seem to realize that when something horrible is happening to you, you're supposed to feel sad. And get moral+emotional support to heal. I always find giving reasons why the misconceptions are wrong busts them the most effectively. Hence my questions on epilepsy.)
no subject
Date: 2010-02-23 01:33 am (UTC)no subject
Date: 2010-02-23 02:19 am (UTC)And that site is also teh awesum! Thanks for posting the link.
no subject
Date: 2010-02-23 04:28 am (UTC)#1. It's not the bullet that causes sepsis, it's the clothing carried in by the bullet. If the bleeding has stopped, that's good enough for survival and there's time to mungle with infection later.
#2. Tourniquets are battlefield medicine for shattered limbs. They have their place in military first aid, and in fact one of the students at Virginia Tech saved his own life with an improvised tourniquet made of an electrical cord, but laypersons should avoid their use. By contrast however, the French teach tourniquets in basic first aid.
#3. Beaten to death already.
#4. Yes! Yes! Yes! This is one of my biggest pet peeves, and one I use to introduce a dose of real world to students who need first aid training for gunshot wounds.
#5. Defibrillators are for stopping V-tac and V-fib. We gloss over this in most CPR training because laypersons tend to freak if they get the erroneous idea that they are doing something that 'stops' the heart. I've been known to explain it to geeks as "CTRL-ALT-DEL" for the heart. ACLS is a witch's brew of defibrillation and various medications, some of which can restart flatline.
#6. The world needs more CPR, not less, however it is a buy-time-for-ACLS move, not a substitute for ACLS. Real world CPR for survivable cardiac events is on the order of 30%. According to some of the Tactical Combat Casualty Care materials I've read, CPR for trauma that stops the heart is more like 1/2 of 1%. And anyone who does CPR on a patient for a bed is doing them absolutely no good. Cf. Michael Jackson.
The comments on the post are priceless FAIL. You can't pay to see stuff this stupid.
no subject
Date: 2010-02-23 02:03 am (UTC)>> Why is the whole belt-in-mouth-to-prevent-biting-off-tongue idea a myth?
It is human nature to want a "magic bullet" answer to a question, a simple solution that can be easily remembered.
To some extent, even teaching that a myth is bad can be a problem because people remember the myth while not remembering that it IS a myth. The mind tends to swallow negatives, particularly under stress, and a direction to "NEVER PUT SOMETHING IN THE MOUTH" can so easily become "PUT SOMETHING IN THE MOUTH."
The medical science is impeccable on this point.
A lay rescuer should keep from putting anything in someone's mouth during a seizure.
The tongue can be an airway obstruction, but not during a seizure event. The tongue can relax and block the airway in an unconscious adult. The way to lift the tongue away from the airway once the seizure has stopped is to do a head-tilt chin-lift, which is a basic first aid airway maneuver. Attempting to manipulate the head during a seizure carries all the risks
A BLS rescuer has protocols for airway management, but will only place an oral airway if needed to secure the airway, and when (typically in a conscious patient or an unconscious patient with a gag reflex) it is not tolerated will then use a nasal airway instead. BLS providers also have suction available in case of aspiration of secretions, blood, etc. This is an important point. If they were to stick something in the mouth, they can suction the resulting blood back out.
Under the supervision of a doctor for example, ALS protocols might allow the use of a bite stick by a paramedic. This DOES NOT mean that a layperson should place one. ALS always has suction and is experienced in its use, with a pile of options including advanced airway adjuncts and medications which are not available to BLS or laypersons.
When I see first aid kits with bite sticks intended for use by lay rescuers, I remove and dispose of them.
Let's imagine that someone who means well does put a bite stick in a seizing patient's mouth, and is willing to risk personal injury (from flailing limbs, bites, etc.) to do so.
1) The bite stick can fall back and endanger the airway itself.
2) The bite stick can stimulate the back of the throat and cause vomiting. Vomit can block the airway. Two tablespoons of vomit is enough to cause aspiration pneumonia.
3) Mouth injuries can result from the teeth and gums smashing against the bite stick. The resulting saliva, secretions, blood and possible teeth can block the airway.
The common theme here is BLOCK THE AIRWAY.
No airway, no patient.
Much, much better to put the person on their side once they have stopped seizing, so that any secretions will flow out the side. Medics prefer the left side due to the stomach anatomy, the kind of detail first aiders are not expected to remember.
In the very unlikely event that someone has stopped breathing, the head-tilt chin-lift followed by rescue breaths is appropriate, going to CPR or rescue breathing based on one's training and findings.
In the event of status epilepticus, or a seizure that has continued for several minutes and will not stop (15% fatality rate), BLS rescuers will use a modified jaw thrust with two rescuers and a bag-valve mask (preferably with high flow oxygen). Lay rescuers should immediately call for emergency services. Direct mouth-to-mouth is impractical for a variety of reasons, including risks of personal injury and bloodborne pathogens exposure.
See also this video on the proper first aid for seizures.
no subject
Date: 2010-02-23 02:21 am (UTC)no subject
Date: 2010-02-23 02:38 am (UTC)no subject
Date: 2010-02-23 04:09 am (UTC)Blanket drag, clothes drag, and foot drag are all accepted techniques for short distance emergency moves. I once tore a student's shirt demonstrating the clothes drag. Both blanket and clothes drag allow some protection for the cervical spine, which is important if a fall is not witnessed or head/neck/back in jury is suspected.
Care must be taken with all to keep from injuring the person, but especially the foot drag as the head tends to drag and wobble up and down. On the other hand, the foot drag is the only technique that works without equipment when the patient weighs >2x what you do.
Short moves can also be accomplished by grasping at the hip and shoulder, this is how you roll a patient on their side.
The most important point (after not injuring yourself, of course) is to protect the head.
Emergency move skills are no fun to teach as they, unlike most other first aid skills, involve some small risk of personal injury if you do it wrong -- just as from picking up or shoving around any other 100 to 300 lb object, but in this case it happens to be a person who could also get hurt.
no subject
Date: 2010-02-23 01:52 am (UTC)As to the "don't try to hold him down" portion of the debate, I had this MASSIVE seizure in school one fine day, and a well-meaning football player twice my size found himself with two black eyes from attempting to do just that -- apparently he caught an elbow in one and a knee in the other. Precisely how is a mystery, as I don't remember too much until I woke up in the nurses office.
Conversely, when I had a seizure after coming of some anti-depressant meds about 10 years ago, Roni was smart enough to keep me from face-planting onto a working wood stove and the brick pad it was on, and kept the area around me clear (fortunately that was a one-off -- I have a great deal of respect for people who somehow manage constant, or even occasional, seizures).
People should learn that entertainment is NOT the best source for life saving techniques -- I remember one medical drama from the late 70's/early 80's where someone "defibbed" a heart attack victim with an extension cord with the two ends stripped. 110 AC wouldn't do the trick, as far as I know. I've often wondered if anyone died because of that bogus tip.
no subject
Date: 2010-02-23 03:41 am (UTC)Odd for those with ACTUAL medical people on the staff.
no subject
Date: 2010-02-23 04:32 am (UTC)But a seizure is usually a dramatic shortcut for "things are seriously wrong, it's an emergency, DO SOMETHING!", and something they do. It would be very disturbing for most to see a medical drama where someone has as seizure and the medical team simply makes the patient safe from injury and stands back and watches and waits.
The same sort of dramatic shortcut is done with defibrillators. More often than not the immediate response in medical dramas to any heart issue is to pull out the paddles. But the audiences don't know what a fibrillating EKG looks like so they show a flatline and zap with those.
Actually..
Date: 2010-02-23 03:34 pm (UTC)no subject
Date: 2010-02-23 04:18 pm (UTC)At least a half-dozen times in the past twenty years, I have been in public with Omaha when she's had a seziure. And every freaking time I have to yell at people to stand back, no she does not need a fucking ambulance, she's fine, no there's nothing else I should do for her, she'll recover, and get your goddamn hands away from her head.
I was on an MMO one day, talking to friends in a common chatspace, when I typed, "Excuse me," and went away. A few minutes later I typed, "Sorry about that. Omaha's having a seziure."
Someone responded, "She's having one? Right now?"
"Yeah. She's on the floor in the living room. I think she bit her tongue; there's a little blood on the pillow."
People were more than a little freaked out. "Shouldn't you be there, doing something for her?" someone demanded.
"There's nothing I can do. Really. She's fine. I can see her from here. When she tries to get up and doesn't know who she is or where she is, I'll get up and make sure she makes it into bed. She always sleeps hard afterward."
Frankly, the real drama comes after Omaha has stared to recover, when she tries to stand up, when she tries to move for herself, and she can't remember who she is or where she left her sense of balance. I'm a little aggressive with her then because, dammit, I don't want her to stand up, fall over, and smack her head.
A well-done drama would be about how other people deal with the blase' attitude of those of us who have been life-long caregivers for epileptics. We've seen seziures a hundred times. I have video tape of them. (Oh, I took a ton of crap from people because I took time to hit [PLAY] on the camera, but Omaha asked me to get it, so now she knows what it looks like from the outside.)
no subject
Date: 2010-02-23 04:35 am (UTC)no subject
Date: 2010-02-23 05:07 am (UTC)no subject
Date: 2010-02-24 04:44 pm (UTC)