Using Epilepsy Rescue Treatments | Epilepsy Foundation

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Talk with your healthcare provider about your seizure action plan and whether you need a rescue medicine.

What are “as needed” or rescue medicines?

“As needed” medicines are only given in specific situations. Some people also call them “rescue treatments.”

• The ideal rescue medicine (1) is easy to use, (2) works quickly, (3) is safe with little to no side effects, and (4) works well.
• The goal is to stop seizures quickly to prevent emergency situations. Hopefully this will prevent you from needing an emergency room. However, rescue medicines do NOT take the place of emergency medical care. If a true medical emergency happens, get emergency medical help right away.
• If medications are prescribed as rescue treatments, they do NOT take the place of daily seizure medications. Most people who have epilepsy are prescribed other medications that they take on a regular basis.
• People who have certain implanted devices for the treatment of epilepsy (such as a vagus nerve stimulator) can use a magnet to swipe over the device generator at the time of the seizure. This is also a form of rescue treatment.

What types of medicines can be used as a rescue treatment?

The most common type of rescue medicines are from a group of medicines called benzodiazepines. These medications get into the bloodstream quickly, to start working in the brain quickly.

• Benzodiazepines are available in several different forms. Depending on the specific benzodiazepine they can be
  • Swallowed in pill form (oral)
  • Placed under the tongue to dissolve (sublingual)
  • Placed between the cheek and the gum to dissolve (buccal)
  • Given via a gel through the anus (rectal)
  • Sprayed up the nose (nasal)
• In a hospital setting, other forms of benzodiazepines can be given by an injection directly into the bloodstream vein or injected into a muscle.
• The names of benzodiazepines that are most commonly used as rescue medications include diazepam, lorazepam, clonazepam, and midazolam.
  • The availability of these medicines in different forms and how they are used may vary from country to country.
  • Also, the brand names of these medications can change depending on the form it is given.
• In the United States, the U.S. Food and Drug Administration (FDA) has approved several medications for out-of-hospital use for the treatment of acute repetitive seizures or clusters.
  • Diastat^® – a diazepam rectal gel
  • Nayzilam^® – a midazolam nasal spray
  • Valtoco^® – a diazepam nasal spray
  • Other medications are commonly used for out-of-hospital rescue treatment but have not yet been approved by the FDA.

How do I choose the right rescue treatment for me?

• Choosing whether you need a rescue medication, and which medication to choose, should be done during a discussion with your healthcare provider about a seizure action plan. The action plan should involves more than just a taking medication and include seizure first aid and when emergency help is needed.
• Things to consider when talking to your healthcare provider:
  • How fast will it work?
  • How will I take it? (mouth, nose, etc…)
  • How easy is it to use?
  • What are the side effects?
  • How much does it cost?
• Some people who remain awake and alert may be able to swallow a pill such as lorazepam or diazepam.
• Other people who are not alert may need to be given a form that can be given under the tongue (sublingual), between the cheek and gum (buccally), or sprayed into a nostril (nasal spray).
  • People who are not able to take these forms can use rectal diazepam; however this is most often prescribed for children.

When should I use my rescue medicine?

Since seizure emergencies are not common, some people with epilepsy will not need to use any treatment other than their daily amount of seizure medicine. However, sometimes seizures occur in a different pattern that is more often or more severe. Several names have used to describe these patterns, such as seizure clusters and acute repetitive seizures. Stopping seizures early in these situations is the key to preventing a seizure emergency.

• There is no one-size-fits-all when it comes to rescue medicines. Since each person’s seizures are different, their seizure action plan and rescue medicine plan should be made specifically for them.
• When discussing with your health care provider, you should have a good understanding of your typical pattern of seizures and be able to recognize when seizures are not typical for you.
• As part of being prepared, ask your healthcare provider if “as needed” medicines are right for you and develop a clear plan with your provider about when they should be used.

General situations when rescue medicines may be recommended:

• Seizures occur that are different than your usual type or pattern.
• Seizures last longer than typical events.
• Seizure occur more frequently than usual
• Seizure clusters are different than usual – for example when more occur than normal or in a shorter period of time.
• Seizures occur at high-risk times – for example, during medicine changes or when sick.

Webinar Recording

Rescue Therapies for Children and Adults

Having a seizure action plan is essential for people living with epilepsy, their families, caregivers, classmates, and colleagues. A good seizure action plan includes information about what to do in the event of a seizure emergency. Watch the video for a discussion with Dr. Lawrence Hirsch and Registered Nurse Nancy Santilli about the latest options in rescue therapies for children and adults.

Webinar recorded on September 1, 2022

Learn More

• Understanding Seizures and Emergencies
• Responding to Seizures
• FDA News: Nayzilam (midazolam) Nasal Spray Approved for Seizure Clusters
• FDA News: Valtoco (diazepam) Nasal Spray Approved as Rescue Therapy for Seizures
• Innovations for Rescue Medications
• Six Questions to Help Decide Whether Your Child Should Have Acute Rescue Medications for Breakthrough Seizures

Authored By:

Matthew Hoerth MD

Patty Obsorne Shafer RN, MN

on Sunday, April 14, 2019

Reviewed By:

Elaine Wirrell MD

on Tuesday, April 14, 2020

Neurology : Managing seizures

• 
  First-aid management of seizures
• 
  When to call an ambulance?
• 
  Administering emergency medication
• 
  General measures
• 
  First-aid courses

First-aid management of seizures

If you are a witness to person having any type of seizure you should use the following simple step by step instructions:

	Major seizures	Minor seizures
	Convulsive seizures with major movement manifestations eg: tonic-clonic, tonic, myoclonic, atonic, and partial motor seizure	Seizures with staring, impaired consciousness or unusual behaviour e. g. complex partial seizures and absence seizures
1	Stay calm	Stay calm
2	Check for medical identification	Check for medical identification
3	Protect the person from injury by removing harmful objects close to them. Loosen any tight clothing or restraints. Place something soft under their head.	Protect the person from injury by removing harmful objects close to them
4	Stay with the person and reassure them. Do not put anything in their mouth and do not restrain them.	Stay with the person and reassure them
5	Time the seizure	Time the seizure
6	When the seizure is over, roll the person onto their side to keep their airway clear	If a tonic-clonic seizure develops, follow major seizure management
7	Treat any injuries	Stay with the person and reassure them, they may be sleepy, confused or combative after the seizure
8	Consider if an ambulance needs to be called (see below)
9	Stay with the person and reassure them, they may be sleepy, confused or combative after the seizure

When to call an ambulance?

It is not necessary to call an
ambulance every time a seizure occurs in a person with known epilepsy. Most people who have epilepsy and have a seizure will recover without difficulty after a few minutes and may only need limited assistance. There are circumstances when an ambulance should be called by dialling 000 on the telephone and these are when:

• The seizure lasts longer than 5-10 minutes
• Another seizure quickly follows
• The person remains unconscious after the seizures ceases
• The person has been injured
• You are about to administer diazepam or midazolam
• You are unsure
• The seizure happens in water
• The person is pregnant or a diabetic
• The person is not known to have epilepsy 

General questions callers will be asked by the ambulance operator

• What is the exact location of the emergency?
• What is your contact phone number?
• What is the problem? What exactly happened?
• What is the age of the person needing the ambulance?
• Is the person conscious?
• Is the person breathing?

Questions asked in an epilepsy emergency

• Has the person had more than one fit?
• Is she pregnant? (If female age 12-50)
• Did the person hit their head before the fit?
• Is the person diabetic or have a history of heart problems?
• Is the person known to have epilepsy?
• Has the jerking (twitching) stopped yet?
  
  (You go and check. I’ll stay on the line)
• Is the person breathing now?

To assist the ambulance

• Avoid third party calls. Whoever is with the person and has the most current, accurate information should speak to the operator.
• Answer each question calmly, accurately.
• Provide accurate location details – the nearest intersection is helpful.
• Have someone wait outside.
• Ring back on 000 if the person’s condition changes.

Administering emergency medication

Some parents or carers may have received special instructions and training to give 
rectal diazepam or intranasal/
buccal midazolam as an emergency treatment for their child’s seizures. This emergency treatment and training only occurs after medical consultation.

General measures

We recommend that all persons with epilepsy or their parents or carers should consider developing an Action Plan in conjunction with their doctor. This plan will provide simple, easy to read instructions on what do if a seizure occurs and help to ensure consistent assistance and interventions from any carers.

You can download an
Epilepsy Management Plan EFV which should be filled in together with your doctor.

Persons with epilepsy should consider wearing a medical ID (such as
MedicAlert) bracelet or necklace and utilise a helmet if prone to frequent falling with seizures. You should always try to take medication as ordered, avoid trigger factors for seizures, recognise potential dangers and adapt the environment to reduce injury risks.

Parents and carers should also consider undertaking a general first aid course which improves confidence in their own abilities to handle situations and may help others. A general first aid course is beneficial for providing assistance in many normal household emergency situations, not just seizure management.

First-aid courses


St John Ambulance (Victoria)

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algorithm of actions during an attack.

Emergency care

Contents

• 1 Angina attack flow chart: how to provide emergency care
  • 1.1 First aid for angina
    • 1.1.1 What is angina?
    • 1.1.2 What symptoms indicate an angina attack?
    • 1.1.3 Algorithm of actions in case of angina attack
  • 1.2 Angina pectoris: what is it?
  • 1.3 Symptoms of angina pectoris
  • 1.4 What to do if you have an angina attack
  • 1.5 Calling an ambulance
  • 1.6 Sedatives for angina pectoris
  • 1.7 Can you take aspirin for angina: warnings
  • 1.8 What to do if your angina worsens
    • 1.8.1 1. Call an ambulance
    • 1.8.2 2. Get into a position that will make breathing easier
    • 1.8.3 3. Take your medications as prescribed by your doctor
    • 1.8.4 4. Follow your doctor’s recommendations for lifestyle changes
    • 1.8.5 5. Seek medical attention if your condition continues to worsen
  • 1. 9 Professional measures for angina pectoris
  • 1.10 Care of the patient after an angina attack
  • 1.11 Tips for preventing angina pectoris
  • 1.12 Conclusion
  • 1.13 Related videos:

  90 006 1.14 Q&A:

  • • 1.14.0.1 What is angina ?
    • 1.14.0.2 What symptoms accompany an attack of angina pectoris?
    • 1.14.0.3 What are the consequences of not providing emergency treatment for an angina attack?
    • 1.14.0.4 What measures help prevent angina?
    • 1.14.0.5 How can emergency care help with angina?
    • 1.14.0.6 What medical procedures can be used to treat angina pectoris?

Find out how to treat emergency angina and what to do if you have an attack. Important recommendations and algorithm of actions on our website. Be prepared for emergencies!

Angina pectoris is a disease characterized by low blood flow to the heart muscle and malnutrition. It can lead to the development of a heart attack if blood circulation is not restored soon. Manifestation of angina pectoris – bouts of suffering that cause discomfort in the chest and inevitably make a person anxious.

In this article, we’ll look at the angina relief algorithm to deal with this dangerous and unhealthy problem. You will learn about the symptoms of angina pectoris, its causes and actions during an attack. We will also look at ways to prevent the disease, which will help to avoid its development and protect your health.

On this page, we provide important information about the first aid and emergency steps to take for angina to maximize heart protection and overall health. Don’t waste your time – get familiar with this important algorithm and learn how to react quickly and efficiently when needed.

First aid for angina

What is angina?

Angina pectoris is a disease in which there are sharp pains in the chest caused by a lack of blood supply to the heart. Typically, an angina attack is triggered by physical exertion or emotional stress.

What are the symptoms of an angina attack?

The main symptom is sharp chest pains extending to the left arm, neck and shoulders. Shortness of breath, sweating, and irregular heartbeats are also possible.

Angina attack flow chart

• Make sure the person has had a previous diagnosis of angina and knows ahead of time what drugs they need;
• Let him sit comfortably and relax;
• Give him the medication he is prescribed (usually nitroglycerin to be put under the tongue) and help him get into a comfortable position;
• Monitor his condition and call an ambulance if he does not feel better after 10 minutes.

Angina: what is it?

Angina pectoris is a disease characterized by bouts of pain or discomfort in the chest that occurs during exercise or stress.

Angina pectoris may be a symptom of a heart condition, such as exertional angina or nonsustained angina, and should be treated immediately.

Symptoms of angina pectoris

Angina pectoris is a disease associated with poor blood supply to the heart. Its symptoms usually manifest as severe pain or discomfort in the chest.

Feeling of tightness may radiate to the neck, arm, shoulders or abdomen. The person may experience a strong feeling of pressure or tightness in the chest. Moreover, the pain may be inferior when taking nitroglycerin.

In some cases, especially in the elderly and women, angina symptoms appear in an unusual format. For example, it can be a feeling of tiredness, shortness of breath, or even nausea.

This disease is serious and requires immediate professional attention. Remember that if you experience severe chest pain, you should call an ambulance immediately!

What to do if you have an angina attack

Be aware that you are having an angina attack.

Sit or lie down, but do not lie on your back.

Relax and take a few slow deep breaths in and out.

Take a nitroglycerin tablet under the tongue. If after 5 minutes the pain has not gone away, repeat the pill.

If you are not allergic to aspirin, take an aspirin tablet.

If pain persists, call an ambulance or go to the nearest medical facility.

Watch your condition and don’t panic.

Call an ambulance

One of the first steps in an angina attack is to call an ambulance. For several minutes, chest pain and the risk of a heart attack may increase. It is important to know that emergency physicians have the necessary knowledge and experience to provide emergency care.

When calling for an ambulance, it is necessary to clearly and clearly explain to the dispatcher the necessary assistance. It is obligatory to inform about an attack of angina pectoris, the presence of a weakening of the pulse and breathing, as well as all medications and chronic diseases taken.

When waiting for an ambulance, try to get the victim into a comfortable position and not leave him alone. At this point, deep breathing and sedative measures can help to ease the attack.

Anginal sedatives

In the event of an angina attack where the patient experiences severe chest pain and anxiety, a sedative may be prescribed. It helps reduce anxiety levels and reduce overall stress.

Another drug that can be used for angina is the anxiolytic lorazepam. It helps reduce levels of anxiety and worry, and contributes to overall relief from pain. This drug must also be prescribed by a doctor and taken only on his recommendation.

1. It is important to remember that you should not take sedatives on your arm.
2. They may have side effects and interact with other drugs you are taking.
3. Therefore, if you experience severe chest pain and anxiety, see your doctor.

Is Aspirin OK for Angina: Cautions

Aspirin is widely used as first aid for heart conditions such as myocardial infarction or angina pectoris. However, unlike myocardial infarction, with angina pectoris, aspirin should be taken more carefully.

Aspirin should not be taken alone if you have unstable angina. In such cases, it is necessary to call an ambulance and take the patient to the hospital.

It is important to understand that angina may not always be “sustained”, some symptoms can lead to chaotic changes in heart rate, which can be dangerous.

If you have moderate angina, you can take aspirin, but only on the advice of your doctor. Usually in this case, aspirin is taken before physical activity or the dosage is reduced to achieve effectiveness.

If you are unsure about your health, do not self-medicate. It is better to consult a doctor who will determine the dose and time of taking aspirin.

What to do if your angina worsens

1. Call an ambulance

If you develop new or worsening symptoms of angina pectoris, try to call an ambulance immediately.

2. Get into a position that will make breathing easier

The position in which you can breathe easier depends on your symptoms. If you experience pressure or heaviness in your chest, you can sit forward. If breathing is difficult, try sitting with your back reclined.

3. Take your medicines as prescribed by your doctor

If you have been diagnosed with angina, your doctor will prescribe medicines to reduce your risk of having a heart attack. Take your medications without interruption and do not change the dosage without your doctor’s permission.

4. Follow your doctor’s recommendations for lifestyle changes

To reduce the risk of heart failure, your doctor may recommend that you lead a healthy lifestyle: quit smoking, lower your blood cholesterol, control your blood pressure, and limit your fat and sugar intake.

5. Seek medical attention if deterioration persists

If your condition worsens over a short period of time or with moderate exertion, see your doctor for additional examinations and treatment adjustments.

Professional measures for angina pectoris

When you have an angina attack, your doctor may take measures to address the cause of the attack. For this, diagnostic studies are carried out, for example, ECG, echocardiography, coronary angiography, which allow us to identify the cause of the disease. Based on the results of the research, treatment is prescribed.

However, preventive measures are also important in angina pectoris. Your doctor may prescribe a diet that limits fats and carbohydrates, as well as exercise to improve physical endurance. Avoidance of stress and moderate sports also contribute to the prevention of angina pectoris.

There are also a number of non-pharmacological methods that can help with angina. For example, methods such as meditation and relaxation exercises are aimed at reducing stress levels and improving the psycho-emotional state.

Care of the patient after an angina attack

After an angina attack, the patient should be kept calm and calm. He should be in a horizontal position, preferably with his legs up. Your doctor may prescribe medications to reduce pain and improve circulation. It is not recommended to give painkillers without a doctor’s prescription, as this can make it difficult to diagnose and exacerbate the problem.

The patient should avoid physical activity, stressful situations and smoking. You should also follow the doctor’s recommendations regarding diet and drug therapy. It is important to visit the doctor regularly and undergo the necessary examinations to monitor your health and prevent new angina attacks.

• Advice: For pain relief, you can ask the patient to put ice on the chest for 15-20 minutes. This will help reduce inflammation and reduce pain. However, the physician should always be aware of the use of ice.

Tips for preventing angina

1. Watch your weight. Excess weight negatively affects the cardiovascular system, so it is important not only to monitor your weight, but also to maintain an ideal body mass index. Regular exercise and proper nutrition will help keep your weight under control.

2. Do not abuse alcohol. Drinking alcohol can lead to hypertension, heart problems and high blood cholesterol levels. So if you drink, do so in moderation.

3. Do annual check-ups. Regular visits to a cardiologist can help detect early cardiovascular disease and heart problems. This will allow you to start treatment in a timely manner and protect yourself from angina pectoris and other serious diseases.

4. Avoid stressful situations. Stress negatively affects our psyche and body as a whole, including the work of the heart and blood vessels. Therefore, try to avoid stressful situations, learn to relax and manage your emotional state.

5. Exercise regularly. Separately, it is necessary to highlight moderate physical activity, which has a positive effect on the cardiovascular system. Regular exercise helps to strengthen the heart muscle, lower blood cholesterol levels and improve the general condition of the body.

Conclusion

Angina is a serious condition that can lead to heart attack and death. This must be kept in mind when taking a patient with complaints of chest pain. It is necessary to conduct a comprehensive diagnosis to determine the degree of damage to the cardiovascular system and the appointment of appropriate therapeutic measures.

An angina attack is a key step in emergency care. It is necessary to call an ambulance, provide first aid, provide the patient with peace and convince him not to panic. It is important to maintain a calm atmosphere and vigilantly monitor the patient’s condition until the arrival of the medical team.

Effective and correct treatment of angina pectoris is a guarantee of success in the fight against this disease. This includes regular medication, lifestyle adjustments, and regular medical check-ups. It is important to take into account all the recommendations of the doctor and follow them until a complete cure.

Related videos:

Q&A:

What is angina pectoris?

Angina pectoris is a condition in which insufficient blood is delivered to the heart, causing a feeling of pressure or pain in the chest. This is usually due to narrowing or blockage of the arteries that supply blood to the heart.

What symptoms accompany an attack of angina pectoris?

Feeling of pressure or discomfort in the chest, a feeling of congestion in the chest (“heaviness”, “squeezing”, “tightness”), a feeling of constriction or constriction in the chest, pain that may radiate to other parts of the body, such as the neck, jaw , back, arms or stomach. In addition, you may experience sweating, nausea, shortness of breath, and feeling weak or tired.

What are the consequences if emergency treatment is not provided for an angina attack?

Late help can lead to myocardial infarction – this is a stoppage of blood flow to the heart, which can lead to increased damage to the heart, and even possibly death.