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Nash-Rocky Mount Public Schools
Student Health Services
Procedure for Seizures
First-Aid, DIASTAT®, and VNS
Nervous System Structure and Function
The central nervous system (CNS) is composed of the brain and spinal cord. The peripheral nervous system (PNS) is
composed of the cranial nerves and peripheral nerves. Cranial nerves in the PNS take impulses to and from the brain (CNS).
Spinal nerves take impulses to and away from the spinal cord. The sympathetic and parasympathetic nervous systems are
division of the autonomic nervous system that control response of internal organs, such as the intestine, bladder, uterus, and
the smooth muscle of the heart. Cerebral spinal fluid fills the ventricular system and arachnoid space around the brain and
spinal cord. The cerebrospinal fluid provides mechanical protection for the brain, distributes neuroendocrine factors, and
helps prevent brain ischemia. Neurons are the cells that process and transmit information in the nervous system.
Motor, sensory, autonomic, cognitive, and behavioral functions are controlled by the nervous system. The cortex is
responsible for cognition; the brainstem and subcortical level control vital signs, equilibrium, and primitive emotion; and the
spinal cord controls motor response.
Seizures
A seizure is a sudden interruption in the normal electrical activity of the brain. It results in a brief state of altered cerebral
functioning. Epilepsy is a condition that makes a child more susceptible to having seizures; a child with two or more
unprovoked seizures is considered epileptic. All students who are being treated for seizures need to have a physicianrecommended seizure action plan. Medications used to treat seizures are chosen base on the type of seizure (chart below).
Adjunct therapies include vagus nerve stimulation (VNS) and ketogenic diet.
Types of Seizures
Partial
Simple partial
Complex partial
Generalized
Absence (petit mal)
Atonic (drop attacks)
Myoclonic
Generalized tonic
clonic
Status epilepticus
Symptoms
Motor: jerking of an
isolated muscle group
Sensory: abnormal
taste, smell, vision,
hearing
Autonomic: nausea,
sweating, pallor
Automatisms: lipsmacking, gagging,
picking at clothes
Motor: running
Emotional: screaming,
crying, or laughing
Symptoms
Blank stare, blinking,
automatisms
(unconscious actions)
Abrupt loss of postural
control, head drop
Sudden brief bilateral
contractions; can be
unilateral and cluster
Flexion followed by
extension, tremors,
and jerking of the
extremities,
incontinence, cyanosis
(bluish color to skin)
Medical emergency;
repetitive without
regaining
consciousness
Approximate Duration
1 minute
Consciousness
Maintained
Postictal period
Weakness or impaired
sensation
1-2 minutes
Impaired
Confusion, lethargy,
amnesia
Approximate Duration
30 seconds
Consciousness
Impaired
Postictal period
Amnesia
Seconds
Impaired
Seconds
Impaired
1-2 minutes
Impaired
More than 5 minutes
Impaired
Lethargy, dysarthria
(difficult/unclear
speech), headache,
confusion, amnesia
Supporting Students with Special Health Care Needs: Guidelines and Procedures for Schools. 3rd Edition. Copyright © 2014. S. Porter, P. Branowicki, and J.
Palfrey. Used with permission.
Updated 2/2/2017
Nash-Rocky Mount Public Schools
Student Health Services
Procedure for Seizures
First-Aid, DIASTAT®, and VNS
Seizure First Aid
Procedure
Points to remember
1. Protect the child from harm.
 Train all staff in seizure first aid.
2. Follow the child’s individual seizure action plan.
 Note the time, duration, characteristics, and
precipitating factors.
 Most seizures will resolve and do not require
emergency medical assistance.
Generalized tonic-clonic seizures
 Gently lower the child to the ground.
 Loosen restrictive clothing.
 Provide something to cushion the head.
 Remain with the child until the seizure is over.
 Place the child on his or her side to keep the airway
 Do not restrain movements; keep the child safe
clear of secretions.
from harming her/himself.
 Do not place anything in the child’s mouth.
Partial seizures
 Comfort the child if he or she appears frightened.
 Remain with the child until consciousness is
regained.
 Reorient as needed.
 Speak calmly and quietly.
 Gently guide the child away from danger; allow to
wander.
Absence seizures
 Assess if child missed any information that was
presented.
Atonic and myoclonic seizures
 Helmet should be worn to protect the head.
 Reassure the child.
 Guide the child to sit down.

Examine for Injury.
Possible problems that require attention
Observation
Reason/Action
This is the first time the child has had a seizure.
Call 911 & notify parent/guardian.
The seizure lasts longer than 5 minutes.
Follow child-specific seizure action plan for emergency
medication administration.
The child:
 Has a 2nd seizure and does not regain consciousness.
 Has stopped breathing.
 Cannot be awakened 30 minutes after the seizure.
 Sustained life-threatening injury during the seizure.
Initiate the Emergency Action Plan (EAP), begin CPR, and call
911. Notify the parent/guardian and physician.
Procedure for Administering DIASTAT® AcuDial™ (diazepam rectal gel)
Procedure
1. Wash hands.
2. Check for prescribed dosage.
3. Inspect the AcuDial syringe for cracks.
4. Apply water-soluble lubricant to tip of dispenser.
5. Instill medication into rectum; hold buttocks for
several minutes.
6. Support safety and respiration until medication is
effective.
7. Individuals who administer should do the following:
 Demonstrate competence.
 Recognize and distinguish the child’s seizures.
 Understand when to administer the medication.
Points to Remember
 Make sure the dose is in the window.
 Make sure the green ready band is locked.




Monitor the child’s response to DIASTAT®.
Follow the child’s seizure emergency action
plan.
Transport to the emergency room.
Contact parent/guardian.
Side Effects: Somnolence, dizziness, headache, pain, vasodilatation, diarrhea, ataxia, euphoria, incoordination, asthma, rash, abd. pain, nervousness, rhinitis.
Supporting Students with Special Health Care Needs: Guidelines and Procedures for Schools. 3rd Edition. Copyright © 2014. S. Porter, P. Branowicki, and J.
Palfrey. Used with permission.
Updated 2/2/2017
Nash-Rocky Mount Public Schools
Student Health Services
Procedure for Seizures
First-Aid, DIASTAT®, and VNS
Vagus Nerve Stimulation (VNS)
VNS is an adjunct therapy for treatment of medically refractory seizures. The goal of VNS is to reduce the frequency or
intensity of seizures or lessen the postictal (recovery) phase. By delivering ongoing preprogrammed electrical impulses to the
vagus nerve, the areas of the brain that are involved in seizure generation or spread are interrupted by the electric stimulus.
The Epilepsy Foundation of America recognizes the use of the VNS magnet as a first aid intervention that can be administered
by the patient himself or herself, school nurse, or trained school personnel.
Patients benefit from early magnet activation; it is recommended that the person who recognizes the onset of a seizure is the
person who provides general seizure first aid and VNS magnet swipe immediately, while others notify the school nurse for
clinical assessment.
VNS has several components:
 Internal:
o VNS pulse generator (similar to a pacemaker).
o VNS lead, which is attached to the vagus nerve.
 External:
o Programmable computer and handheld wand for the clinician to adjust settings.
o Magnet for the child/caregivers to manually trigger the delivery of impulses.
VNS equipment has settings that can be individualized and adjusted to alter the treatment’s effect on seizure activity or
tolerance:
 Power of the stimulus (mA).
 Duration of the stimulus, programmed for on time (seconds) and off time (minutes).
The VNS magnet has several uses:
 It can stimulate a higher current dose of stimulation during an aura or at the onset of a seizure.
 It can reduce the duration of seizure, prevent a cluster, or reduce the postictal (recovery) phase.
The VNS checklist can be used as a foundation for competency-based training in appropriate techniques. It outlines specific
procedures step by step. Once the procedure have been mastered, the completed checklist serves as documentation of
training.
Procedure for using the vagus nerve stimulation (VNS) magnet
Procedure
When to use the magnet
 If the student experiences an aura, to hopefully
prevent a seizure.
 At the onset of the seizure, to hopefully abort or
reduce the length of intensity of the seizure.
How to use the magnet
 The student or a caregiver educated in the
recognition of seizure character and use of the
magnet swiping technique can swipe the VNS.
 Swipe at first recognition of an aura or onset of a
seizure.
Points to Remember
 The magnet swipe will provide a higher current
(mA) than the routine current setting for 60
seconds.

The magnet can be reswiped in intervals of 60
seconds until the seizure stops or other
emergency treatment is necessary.

The magnet is powerful enough to be swiped
over clothing layers.
Magnet:
Generator:
Recommended techniques
 The magnet is swiped slowly over 3 seconds in a
diagonal direction from the center of the left clavicle
to the left armpit.
 The magnet is swiped slowly over 3 seconds in a
paintbrush technique of down and up from the left
clavicle to the left armpit.
Supporting Students with Special Health Care Needs: Guidelines and Procedures for Schools. 3rd Edition. Copyright © 2014. S. Porter, P. Branowicki, and J.
Palfrey. Used with permission.
Updated 2/2/2017
Nash-Rocky Mount Public Schools
Student Health Services
VNS Procedure – Cont.
How to store the magnet
 Magnets should be worn on the student’s wrist or
belt for easy access.
 The magnet can be held by a staff member or kept
in a backpack or other easily accessed location.
When to turn off the device
 If the student has voice changes during stimulation
and would like to avoid this during public speaking
or singing.
 When determining if the VNS stimulation is causing
side effects or discomfort.
Procedure for Seizures
First-Aid, DIASTAT®, and VNS
VNS Points to Remember – Cont.
 Do not place magnet in the student’s chest
pocket, as the proximity to the generator may
inadvertently turn the device current off.
 Keep the magnet 10 inches away from credit
cards, computers, microwave ovens, watches,
or other magnets.
 The student may pass through antitheft or
metal detectors without affecting the
generator.
 Cell phones do not affect the VNS generator.
 The VNS must be interrogated and reset after
magnetic resonance imaging (MRI).
Possible problems related to vagus nerve stimulators
Observations
Incision site discomfort immediately post-operatively.
Reason/action

These are potential side effects. Call parents
and seek medical attention.

This is a serious side effect. Initiate the EAP,
begin CPR if necessary, and call 911. Notify
parent/guardian and physician.
Change in voice, hoarseness, or tingling in the neck during
the cycle of stimulation.
Continuous hoarseness or throat pain, choking, or difficulty
breathing or swallowing.
Supporting Students with Special Health Care Needs: Guidelines and Procedures for Schools. 3rd Edition. Copyright © 2014. S. Porter, P. Branowicki, and J.
Palfrey. Used with permission.
Updated 2/2/2017