((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.))

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.

• Ensure scene safety — clear bystanders from immediate area, ensure patient is away from hard or sharp objects.
• Protect patient from injury — place padding beneath head, do not restrain limbs.
• Complete Primary Survey — open and clear airway using suction to clear saliva pooling in oropharynx.
• Insert nasopharyngeal airway (NPA) — preferred over OPA given risk of trismus in post-ictal state; do not attempt to force OPA into clenched jaw.
• Place patient in lateral position (recovery position) — to facilitate drainage of secretions and protect airway while unresponsive.
• Apply oxygen via non-rebreather mask (NRB) at 10–15 L/min — titrate to target SpO2 94–98%.
• Perform full Vital Signs Survey — GCS, BGL, SpO2, pulse oximetry, temperature, RR, BP, HR.
• 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.
• Obtain SAMPLE history from husband via phone — confirm known epilepsy, sodium valproate, missed morning dose.
• Record and repeat vital signs every 10 minutes (or 5 minutes if patient remains time critical).
• Complete Secondary Survey once seizure has terminated and patient is sufficiently responsive — assess knee abrasion, manage with wound dressing and direct pressure as required.
• 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.
• Manage knee abrasion — irrigate with sterile NaCl 0.9%, apply non-adherent dressing and crepe bandage.
• Continue to monitor for further seizure activity — repeat seizure or prolonged seizure (>5 minutes) indicates Priority 1 transport and pre-notification of receiving facility.
• Request ambulance for transport to hospital — seizure in a patient with known epilepsy warrants ED review, particularly given missed medication and hypoglycaemia.
• Scenario ends on arrival of ambulance and IMISTAMBO handover.
• 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