A nurse is caring for a patient who is experiencing a generalized tonic-clonic seizure. Which action should the nurse take first?

Scenario: A patient exhibits a sudden loss of consciousness, rigid muscle contractions, followed by rhythmic jerking of all extremities.

1. Position the Patient: Immediately turn the patient onto their side (recovery position) to maintain a patent airway and allow oral secretions to drain, reducing the risk of aspiration.
2. Protect the Head: Place a soft, flat object like a folded blanket or jacket under the patient's head to prevent blunt trauma. Remove any sharp or hard objects from the immediate vicinity.
3. Time the Seizure: Note the exact start time of the tonic-clonic activity. A seizure lasting 5 minutes or longer, or recurrent seizures without a return to baseline, constitutes status epilepticus and requires emergency medical intervention.
4. Clear the Area: Remove nearby furniture, equipment, or any objects that could cause injury during the uncontrolled movements.

• Do Not Insert Objects into the Mouth: Never place a tongue blade, bite block, or fingers in the patient's mouth. This is a common myth and can result in broken teeth, oral injury, airway obstruction, and aspiration. A person cannot swallow their tongue.
• Do Not Restrain the Patient: Do not hold down or restrain the patient's arms or legs. Physical restraint will not stop the seizure and can cause musculoskeletal injuries such as dislocations or fractures.

1. Assess Airway and Breathing: Once jerking movements cease, reassess the patient's airway, breathing, and circulation (ABCs). Suction the airway if necessary.
2. Administer Oxygen: Apply supplemental oxygen via nasal cannula or mask if the patient is hypoxic, as they are often in a state of respiratory depression or acidosis immediately following a seizure.
3. Reorient and Reassure: The patient will likely be confused and fatigued. Provide a calm, quiet environment and reorient them to person, place, and time.
4. Document the Event: Record the duration, body parts involved, progression of motor activity, and the patient's condition before, during, and after the seizure.

Reference: Aligned with 2025 Korean Guidelines for CPR and international consensus on seizure first aid, which prioritize non-invasive protective interventions to prevent secondary injury and aspiration.