Seizures, lateral decubitus, aspiration, and shoulder dislocation - Time to change the guidelines?

The recommendation to position a patient having a seizure on a lateral decu bitus is aimed at minimizing the risk of aspiration. The authors reviewed t he database of the Epilepsy Foundation Clinic of South Florida for patients with epilepsy treated for pneumonia between May 1999 and May 2000 and pati ents admitted to two university telemetry units who had dislocation of the shoulder during an epileptic seizure. Over 2 months, 2 of 733 adults with i ntractable seizures had aspiration pneumonia after a generalized tonic clon ic seizure (GTCS). Although no study has specifically addressed the problem of aspiration pneumonia in adults with GTCS, our findings suggest this pro blem is not common. From the two epilepsy centers, 5 of 806 patients disloc ated a shoulder during a seizure. Video recordings showed that these patien ts were positioned in a lateral decubitus by staff while still having the c onvulsion. The dislocated shoulder in all cases was on the lower side. The risk of shoulder dislocation in a convulsing patient positioned in a latera l decubitus is less than 1%. Nevertheless, dislocations can result in disab ling recurrences and are easily preventable. Because aspiration is more lik ely in the postictal rather than ictal phase of a GTCS, when oral secretion s are not usually increased and there is cessation of respiratory movements , lateral decubitus should only be implemented after cessation of the convu lsion. In inpatients (such as those on telemetry), secretions may be better managed by bedside aspiration of the oral cavity.