Case Study 10

The Scenario: Seizure in Camp

The Setting

It’s early September. You’re leading a college orientation group on a four-day backpacking trip. It’s 1500 hrs (3:00 PM) on a nice, sunny day. You arrived in camp about 30 minutes ago. 

Suddenly you hear one of the participants yelling, “Jerome is having convulsions!” You remember talking to Jerome about his history of seizures and that he has not had a seizure in a year. You walk quickly to Jerome. Your heart is racing, your palms are sweating, and you feel your breathing quicken as you click into the habit of scene size-up and initial assessment. Jerome is actively seizing with a spoon tinged with blood in the corner of his mouth. 

You kneel next to the patient and cradle his head in your hands. You remove the spoon from his mouth. He seems to have an airway and is nosily breathing, which improves when you wipe saliva from his mouth. There is no active bleeding and no obvious injuries. Jerome is not responding to voice or pain. You look around and see a lot of anxious campers staring at the scene.  You tell them it’s a seizure, Jerome will be ok and ask them to calm down while you think, "Vitals...head-to-toe...sample." 

SOAP Report

The patient is a 19-year-old male whose chief complaint is seizure activity. Patient was in camp when he was witnessed rolling out of his “crazy creek” chair onto the ground where he actively seized with generalized muscle contractions for approximately 45 seconds. I witnessed the final 10-15 seconds of the seizure, saw generalized muscle tremors, and removed a plastic spoon from the patient’s mouth. The patient is currently unresponsive. 


Patient Exam
The head to toe revealed a half-inch laceration on the tip of the tongue. Airway is otherwise intact. No other injuries were found. 

Vital Signs  

TIME     1500 hrs 
 LOR  Unresponsive.  Patient does not react to pain stimulus.
 HR  100, strong, regular
 RR  22, regular, noisy
 SCTM  Pale, cool, clammy
 B.P.  Radial pulses present
 Pupils  PERRL
 T°  Not taken


Symptoms:  Patient is unresponsive.
Allergies:  Unknown
Medications:  Dilantin for his seizures at 100mg three times daily.
Pertinent Hx: History of seizures. Seizure-free for one year.
Last in/out:  Bystanders say he was drinking water all day and ate lunch. Patient urinated during seizure.  
Events:  Hiking, then this seizure.

Stop ...

What is your Assessment and Plan?

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