Scenario — Post-ictal seizure at community fun run

foundation Neurological · Adult · 35yr · female

Patient Information

Dispatch	You are called to a patient (Sarah Nguyen, 35-year-old female) who is on the ground near the finish line of the Perth City Fun Run. Bystanders report she collapsed and was shaking for approximately 2 minutes.
Patient	Sarah Nguyen — 35yr (65kg)
Incident History	Pt was observed crossing the finish line when she suddenly collapsed to the ground and began having generalised shaking movements lasting approximately 2 minutes. Shaking has now stopped. Pt is on the ground, unresponsive to voice.
Emergency Contact	David Nguyen (Husband) — 0412 847 193

Initial Rapid Assessment

Response	Pain
Airway	Airway partially obstructed by saliva pooling in oropharynx. No vomit, no stridor. Tongue not bitten through.
Breathing	Breathing present but slow and shallow. RR approximately 10. No wheeze or crackles audible.
Circulation	Radial pulse present, regular, moderate strength. Skin warm and diaphoretic. No external bleeding.
Disability	GCS 9 (E2V2M5). Not orientated to time, place or person. Post-ictal state. Pupils equal and reactive to light bilaterally.
Exposure	No visible rashes or injuries. Mild abrasion to left knee consistent with fall. Running attire. No medic-alert jewellery visible on initial inspection.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	91% (RA)	Mild	10	104	118/74	<2s	9	4 4 ++	37.8	3.6 mmol/L	–
10 mins	98% (O2 NRB 15L/min)	Nil	14	92	122/76	<2s	13	4 4 ++	37.8	3.6 mmol/L	2

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from a generalised tonic-clonic seizure (now post-ictal) in the context of known epilepsy, likely precipitated by missed anticonvulsant medication, physical exertion, and mild hypoglycaemia.

Facilitator Triggers — if trainees miss a critical step

! (If trainee does not check BGL within first 2 minutes: patient's GCS drops to 7 and airway becomes increasingly obstructed by secretions — prompt trainee to perform BGL as part of full vital signs survey.)
! (If trainee does not apply oxygen within 3 minutes: SpO2 drops to 88% on room air and respiratory rate decreases to 8 — prompt trainee to address breathing and apply supplemental oxygen.)
! (If trainee attempts to force an OPA into a clenched jaw or force anything into the patient's mouth during active seizure: facilitator advises this causes injury and directs trainee to use an NPA instead and suction if required.)
! (If lateral position is not applied while patient remains unresponsive: patient produces audible gurgling from saliva pooling — prompt trainee to position patient appropriately to maintain airway.)
! (If BGL is identified as 3.6 mmol/L and glucose gel is not considered: facilitator prompts trainee to reassess BGL against the 4 mmol/L treatment threshold.)

Treatment Objectives

1. Ensure scene safety — clear bystanders from immediate area, ensure patient is away from hard or sharp objects.
2. Protect patient from injury — place padding beneath head, do not restrain limbs.
3. Complete Primary Survey — open and clear airway using suction to clear saliva pooling in oropharynx.
4. Insert nasopharyngeal airway (NPA) — preferred over OPA given risk of trismus in post-ictal state; do not attempt to force OPA into clenched jaw.
5. Place patient in lateral position (recovery position) — to facilitate drainage of secretions and protect airway while unresponsive.
6. Apply oxygen via non-rebreather mask (NRB) at 10–15 L/min — titrate to target SpO2 94–98%.
7. Perform full Vital Signs Survey — GCS, BGL, SpO2, pulse oximetry, temperature, RR, BP, HR.
8. Assess BGL — result 3.6 mmol/L is below 4 mmol/L threshold. As patient is currently GCS 9 and cannot safely ingest orally, do NOT administer glucose oral gel at this stage; reassess GCS before considering oral glucose — monitor closely and reassess in 5 minutes as GCS improves.
9. Obtain SAMPLE history from husband via phone — confirm known epilepsy, sodium valproate, missed morning dose.
10. Record and repeat vital signs every 10 minutes (or 5 minutes if patient remains time critical).
11. Complete Secondary Survey once seizure has terminated and patient is sufficiently responsive — assess knee abrasion, manage with wound dressing and direct pressure as required.
12. Reassess GCS at 10 minutes — as GCS improves to 13 and patient can safely ingest orally, administer Glucose Oral Gel 15g orally and follow up with complex carbohydrates once fully conscious.
13. Manage knee abrasion — irrigate with sterile NaCl 0.9%, apply non-adherent dressing and crepe bandage.
14. Continue to monitor for further seizure activity — repeat seizure or prolonged seizure (>5 minutes) indicates Priority 1 transport and pre-notification of receiving facility.
15. Request ambulance for transport to hospital — seizure in a patient with known epilepsy warrants ED review, particularly given missed medication and hypoglycaemia.
16. Scenario ends on arrival of ambulance and IMISTAMBO handover.
17. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Seizures · Hypoglycaemia · Glucose Oral Gel · Oxygen · Suction · Nasopharyngeal Airway · Lateral Position · Blood Glucose Monitor · Primary Survey · Secondary & CNS Survey · Minor Wound Management

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Signs/Symptoms	Post-ictal drowsiness, confusion, mild headache on regaining consciousness. Left knee abrasion from fall.
Allergies	Nil known
Medications	Sodium valproate 400mg twice daily (known epileptic — confirmed by husband on phone)
Pertinent History	Known epileptic — diagnosed age 22. Last seizure approximately 8 months ago per husband. Pt states she may have forgotten her morning medication today.
Last Oral Intake	Small banana and water approximately 2 hours prior to event.
Events Leading	Pt was participating in the 10km Perth City Fun Run. Completed the race and collapsed immediately after crossing the finish line.
Treatment Prior	Bystanders placed pt in recovery position and kept crowd back. Nil medications given.

Onset	Sudden collapse at finish line approximately 5 minutes prior to EHS arrival. Shaking lasted approximately 2 minutes and had ceased before EHS arrived.
Pain	Headache 3/10, left knee abrasion 2/10 once conscious enough to respond.
Quality	Generalised tonic-clonic shaking observed by bystanders. No aura reported by patient on recovery.
Radiates	Nil
Severity	Headache 3/10