"He's seizing! Stick a shoe in his mouth!"

hippocratical

hippocratical

Forum Lieutenant
Messages
144
Reaction score
0
Points
0
Just wondering, but where did laypeople get the idea that it's a good thing to stick something in the mouth of someone having a seizure?

Years ago I was in a hostel bar where some dude had a grand mal, and bystanders started offering their sandals to stick in the poor bugger's mouth. Despite having no training at the time, I still knew that was a bad idea and had to fend them off!

Is it from some old protocols? War movies where they 'bite the bullet'?

(BTW for those interested, the guy was fine: finished his horizontal dance, postictal for a few mins, confirmed he was off his meds, taxi to hospital for checkup)
 
I saw the same thing while vacationing in Ireland. They were trying to put spoons, shoes, and a wallet in the guys mouth. Then some woman walks up, proclaims "I AM A NURSE!!" and states that we need to keep his hands above his knees. I was very perplexed.
 
The reason is because the pervasive old school of thought was that it was prudent to prevent someone from biting through their tongue. When I was first certified over 20 years ago, they were teaching us to place a bite stick between the teeth.
 
Because sometimes when people have a seizure they can bite their tounges. So putting something in their mouth was a way to prevent that. I've heard alot of stories of regular citizens doing this but the object they used gets bitten in half and almost starts to choke the patient.

Going thru one of our ALS bags about 2 weeks ago we actually found a seizure bite stick.
 
firefite said:
Going thru one of our ALS bags about 2 weeks ago we actually found a seizure bite stick.
Click to expand...

We still have them on our rigs...they're great for administering oral glucose.

Sent from my Android Tablet using Tapatalk
 
we have bite sticks! No one can say what for though.. money waster!
 
I've also seen bystanders stick their hands in a seizing patient's mouth "so they don't swallow their tongue". Those fingers end up severely damaged (note to self: lit review on digit amputation following attempted heroics). I've also seen bystanders hold down the appendages of a seizing person "to make the shaking better", or my favorite, sticking 2 ammonia inhalants in each nostril "so they wake up faster".
 
I thought is was something like that. Strange in the Emergent setting though, for if someone is having a seizure, and we are called, by the time we get there they've finished. Sure, they can have more and then you're ready with your bite sticks, but still.

Anyhow, it reminds me of the Far Side cartoon:

farside-dentist.jpg
 
I guess after a while people began to notice that seizure patients really DIDN'T bite through their tongues, but "bite-sticks" were SOP for a generation or two.
 
We still carry bite sticks too. They make great splints for finger injuries. They'd also work okay for improvised tourniquets with a cravat.
 
I've never seen someone in a seizure bite their tounge but I've seen em bite the heck out of their cheek a couple of times. One guy we had on the plane bit his cheek so bad it looked like he was vomiting blood for a few seconds.
 
OP, back to your question...

Lost in the sands of time.

Maybe it was like this:
1. Pt bites tongue and or cheek and aspirates blood, causing airway embarassment.
2. Grand mal, accompanied by coincidental oral bleeding, results in hypoxia, but the blood is blamed.
3. They actually used to teach you to put a spoon in their mouth to hold the tongue forwards so they wouldn't swallow it.

They used to sell a big plastic screw with wingnut wings on top to screw open the jaw in trismus.

I've seen a bitten tongue, but not bitten off. If it was, the bitten off part would be betwen the tongue and lower lips or the buccal area, so not an airway problem until the trismus ends.
 
Sasha said:
we have bite sticks! No one can say what for though.. money waster!
Click to expand...

To prevent a patient from biting on the tube once they have been intubated....if you do not have a proper tube holder with bite block in it already.
 
bite sticks are great for spreading peanut butter, getting occbld samples on the smear pad. Other than that they rarely ever get used in our ER
 
mycrofft said:
3. They actually used to teach you to put a spoon in their mouth to hold the tongue forwards so they wouldn't swallow it.
Click to expand...
I've heard this more often than I care to admit.

I always wonder where this came from. who used to actually teach it? with it an actually agency or just an old wives tale passed down from generation to generation? and did they not know that you can't swallow your tongue, because it is attached to the bottom of your mouth?
 
Heck, first aid classes taught it when I was a kid.

The tongue falling back to embarass the oropharyngeal airway is a common post-ictal (or post mortem) problem if the pt is left supine and not prone or in a recovery position after a seizure. (I mention post mortem because a grand mal seizure can kill you, and when the trysmus lifts and you look into the mouth, hey presto, tongue in throat). It won't go down the esophagus, but it will appear to be retreating thataway if you open the mouth of a slack unconscious or dead person who is supine or even sitting with head tilted back.

The plastic bite sticks (or "surfboards" as some of us called them) alays seemed risky. If they were slick and you pinched them, they'd shoot away like a watermelon seed. I never trusted them not to do the same down the oropahrynx!
 
My epileptic dad has never bitten his tongue. He did tend to have snoring respers and seemed to have a faster return from postictal-land once I learned to lay him on his side.

Sent from my telefono
 
In a basement for a "pre-ictal" party.

Me: Sir, why do you have a spoon in your mouth?
Pt: inmfcfmffimfffrfff
Me: Try it without the spoon.
Pt: In case I have a sz.

Jeff
 
Dumb question

Why isn't there a local injection to relax trysmus? Say, botox, or succinocholine?
 
You must log in or register to reply here.
Back
Top