Explain the treatment that would be provided for this patient.

A 32-year-old female presents with a positive medical history. She indicates that she has seizures that are not controlled with medication. The patient is scheduled for an initial examination. The dentist has become involved in an extensive procedure, and the patient is kept waiting in the operatory. During this time, she becomes very anxious about the upcoming treatment. The dentist enters the operatory and begins treatment. The patient is very quiet and starts to twitch. She then proceeds to a full tonic-clonic seizure.

What will be an ideal response?

Treatment:
1. Remove all dental objects from the patient’s mouth.
2. Remove dental equipment on which the patient may hit and injure herself, but if possible, do not move the patient.
3. Remove glasses and loosen tight clothing such as neckties. Dentures or partial dentures should remain in the patient’s mouth unless they are causing an airway obstruction.
4. Call EMS. There is always a possibility of injury during a seizure. Furthermore, if the patient stops breathing and does not recuperate immediately or if the seizure seems to pass from one episode right into the next, which would indicate the possibility of status epilepticus, EMS would need to be on site.
5. Do not force anything into the patient’s mouth.
6. Do not restrain the patient.
7. A pillow or soft towel should be placed under the patient’s head to prevent injury.
8. Once the seizure has ended, turn the patient on one side so any secretions are not aspirated. Remember during the entire seizure that an opened airway must be maintained above all else.
9. The patient who begins to regain consciousness needs reassurance and may be confused as to what happened and what day it is. Also, most patients will be embarrassed by the episode; you should do whatever possible to alleviate this embarrassment and maintain the patient’s dignity.
10. Do not give the patient anything to eat or drink until she is fully alert.