An unresponsive 58-year-old female who had a seizure and has a brief tonic phase followed by clonic activity should be managed next by:

• A. Remove her clothing and begin to cool her.
• B. Administer oxygen by nasal cannula and assess her vital signs.
• C. Assess her blood glucose level and administer oral glucose if needed.
• D. Protect her head and begin transport.

Answer: (D)

During a seizure, the highest priority is safety and rapid transport. An unresponsive patient after the convulsive phase is at risk for airway compromise and injury, so the immediate action is to protect the head to prevent trauma and prepare for transport to a hospital for definitive evaluation and treatment. While supplemental oxygen can be provided if there are signs of hypoxia, it does not replace the need to safeguard the airway and get the patient to care promptly. Giving oral glucose is unsafe in an unresponsive patient who cannot protect the airway and could cause aspiration, and cooling is not indicated unless there is fever or hyperthermia.