Tonic-clonic seizures, formerly known as grand mal seizures, comprise two stages: a tonic phase and a clonic phase. These intense seizures can be frightening to experience or observe, as extreme muscle spasms may temporarily arrest breathing. Show
What You Need to Know
Symptoms of a Tonic-Clonic (Grand Mal) SeizureAuraThe seizure may start with a simple or complex partial seizure known as an aura. The person may experience abnormal sensations such as a particular smell, vertigo, nausea, or anxiety. If the person is familiar with having seizures, they may recognize the warning signs of a seizure about to begin. Tonic ActivityWhen the tonic-clonic seizure begins, the person loses consciousness and may fall. Strong tonic spasms of the muscles can force air out of the lungs, resulting in a cry or moan, even though the person is not aware of their surroundings. There may be saliva or foam coming from the mouth. If the person inadvertently bites their tongue or cheek, blood may be visible in the saliva. Stiffness of the chest muscles may impair breathing, the person’s face may look bluish or gray, and he or she may make gasping or gurgling sounds. Clonic ActivityJerking movements affect the face, arms and legs, becoming intense and rapid. After one to three minutes, the jerking movements slow down and the body relaxes, sometimes including the bowel or bladder. The person may let out a deep sigh and return to more normal breathing. After the Seizure (Postictal Period)After a seizure, the person may remain unconscious for several minutes as the brain recovers from the seizure activity. He or she may appear to be sleeping or snoring. Gradually the person regains awareness and may feel confused, exhausted, physically sore, sad or embarrassed for a few hours. The person may not remember having a seizure, and may have other memory loss. Occasionally, people may have abnormal or combative behavior after a tonic-clonic seizure while the brain is recovering. What to Do If Someone Has a Tonic-Clonic (Grand Mal) SeizureWitnessing a person having a tonic-clonic seizure can be upsetting, but it’s important to remember that most seizures resolve on their own after one to three minutes. To offer assistance:
Diagnosis and Treatment of Tonic-Clonic (Grand Mal) SeizuresAfter a person’s first seizure, it is important to consult with a physician. Parents or family members who observe the seizure can note the details and help create a written report that the person can take to the doctor. A video recording of the event (if available) can also aid in diagnosis. To ascertain the cause of the seizure, the doctor may prescribe magnetic resonance imaging (MRI) or other tests to look for scarred areas in the brain. Electroencephalography (EEG) can help distinguish seizure disorders from other conditions. If the doctor determines the person has a seizure disorder such as epilepsy, an individualized approach to treatment can help manage it. A range of therapies, including anti-seizure medication, nerve stimulation, dietary therapy and surgical procedures can address the seizures and, in many cases, bring them under control. What are needlestick injuries?Needlestick injuries are wounds caused by needles that accidentally puncture the skin. Needlestick injuries are a hazard for people who work with hypodermic syringes and other needle equipment. These injuries can occur at any time when people use, disassemble, or dispose of needles. When not disposed of properly, needles can hide in linen or garbage and injure other workers who encounter them unexpectedly. What are sharps?"Sharps" include needles, as well as items such as scalpels, lancets, razor blade, scissors, metal wire, retractors, clamps, pins, staples, cutters, and glass items. Essentially, any object that is able to cut the skin can be considered a "sharp". What are the hazards of needlestick and sharps injuries?These injuries transmit infectious diseases, especially blood-borne viruses. Concern includes the Human Immunodeficiency Virus (HIV) which leads to AIDS (Acquired Immune Deficiency Syndrome), hepatitis B, and hepatitis C. Incidental punctures by contaminated needles can inject hazardous fluids into the body through the skin. There is potential for injection of hazardous drugs, but contact with infectious fluids, especially blood, is by far the greatest concern. Even small amounts of infectious fluid can spread certain diseases effectively. Sharps can create a cut in the skin which allows contact between blood, or fluids. The risk of infection after exposure to infected blood varies by bloodborne pathogen. The Ontario Hospital Association/Ontario Medical Association (2016) estimate that after an injury in workplace situations from a needle contaminated with hepatitis B virus, there is a 6 to 30% chance that an exposed person will be infected. In a similar situation with HIV, there is about a 0.3% chance of infection, and there is about a 1.8% chance of infection for hepatitis C. Note also that because the hepatitis B virus may survive on environmental surfaces for more than a week, indirect exposure can occur via contaminated inanimate objects. Injuries have transmitted many other diseases involving viruses, bacteria, fungi, and other microorganisms to health care workers, laboratory researchers, and veterinarian staff. The diseases include:
Many of these diseases were transmitted in rare, isolated events. They still demonstrate, however, that needlestick and sharps injuries can have serious consequences. How do needlestick injuries occur?Injuries can occur at every stage of their use, disassembly, or disposal. A report from the Centers for Disease Control and Prevention (CDC) in the United States lists the following percentages for injury rates from a study with data collected from 1995 to 2007: Injuries involving hollow-bore needles:
Injuries involving solid sharps:
Equipment design, nature of the procedure, condition of work, staff experience, recapping, and disposal have all been mentioned as factors that influence these occurrences. How can needlestick and sharps injuries be prevented?Preventing injuries is the most effective way to protect workers. A comprehensive sharps injury prevention program would include:
The Centre for Communicable Diseases and Infection Control at the Public Health Agency of Canada (PHAC) reviews, publishes, and updates guidelines to protect staff from exposure to all infection causing agents in healthcare settings. The current guideline is titled "Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings". Preventing injuries from sharps and needlesticks is considered a part of the "routine practices" used by healthcare workers. Workers who use sharps require education and training as part of a sharps injury prevention program. Workers should be educated in how to protect themselves during use, and to protect others who may encounter the device during or after procedures. The use of safety-engineered devices such as protected needle devices, or needle-free systems with self-sealing ports and syringes is encouraged. PHAC states that use of such safety devices is required by some jurisdictions. Using these devices must take into consideration both the safety of the health care worker and the patient. PHAC recommends that:
PHAC also refers to the CDC "Workbook for designing, implementing and evaluating a sharps injury prevention program" as an example of a program. This workbook uses a hierarchy of control approach, including: Elimination - find ways to eliminate or reduce needle use during procedures, medication delivery, and specimen collection. Engineering controls - remove or isolate the hazard by using sharps disposal containers or other devices that have an integrated injury prevention feature. Safety devices must be chosen with care as no one device or strategy will work in every situation. Work-practice controls - Steps that can be taken to reduce injuries include using instruments to grasps needles or load/unload scalpels, avoiding hand-to-hand passage of sharps, separating sharps from other waste, not carry garbage or linen bags close to the body, etc. Personal Protective Equipment (PPE) - PPE should be used as the last control approach, where appropriate. In situations where recapping is considered necessary, develop safe approaches which workers can follow. Workers should never move an exposed needle tip towards an unprotected hand. Recap by laying the cap on a flat surface and scoop it onto the tip of a syringe held in one hand. Keep the free hand away from the sheath and well behind the exposed needle. In addition, all workers at risk should be aware that there is a vaccine available for Hepatitis B. How should sharps be disposed of?An effective system for disposing of used needles and sharps is crucial to preventing injuries. Have disposal containers readily available. Workers should place needles in wide-mouth, puncture-proof containers. Locate disposal containers specifically where needles and sharps are used to make safe disposal possible. Replace the containers before they are completely filled - sharps containers should be removed and replaced when they are three quarters full. Make sure they are sealed, collected, and disposed of in accordance with local regulations for biomedical waste. All staff should report every incident in which they find needles or sharps left at the bedside or thrown into the regular garbage. What steps are involved with a surveillance program?Surveillance programs that provide in-depth analysis of accidents are an important tool for obtaining information. The goals of these programs should include:
Which action would be most appropriate when caring for a person who is bleeding?Stop the bleeding.
Place a sterile bandage or clean cloth on the wound. Press the bandage firmly with your palm to control bleeding. Apply constant pressure until the bleeding stops. Maintain pressure by binding the wound with a thick bandage or a piece of clean cloth.
What are the steps to stopping severe bleeding quizlet?Apply direct pressure to the wound, then apply a pressure bandage. Compress an artery at a pressure point and then apply direct pressure to the wound. Elevate the wound and then apply a tourniquet. Apply direct pressure to the wound, then apply a pressure bandage.
What are actions to take to make and apply a tourniquet to stop major bleeding quizlet?Scene safety.. Fold cloth bandage so it's at least one inch wide.. Wrap bandage 2 inches above injury site.. Tie the ends of the bandage to something like a stick, hand tool, or pencil.. Turn the item to tighten the tourniquet.. Tighten until the bleeding stops.. Secure the item so that it stays tight.. What are two ways to tell if bleeding is lifeList two signs and symptoms of severe, life-threatening external bleeding. Blood spurting or pouring from the wound; bleeding that fails to stop after direct pressure is applied.
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