Prolonged Seizure with Respiratory Arrest in a Resource-Limited Setting: A Case Managed During an Annual Project World Health Trip in the Dominican Republic
DOI:
https://doi.org/10.65539/j85zex87Keywords:
seizure emergency, ictal central apnea, epilepsy, global health, resource-limited setting, interdisciplinary care, team-based managementAbstract
Seizure emergencies in low-resource settings present unique challenges due to limited access to diagnostics, antiepileptic medications, and emergency services. Global health literature emphasizes the importance of rapid, coordinated interventions when standard treatments are unavailable. During the 2025 Project World Health (PWH) service-learning trip in Jarabacoa, Dominican Republic, a male in his early-mid teens with a history of syncopal episodes presented to a temporary outreach clinic. While awaiting referral planning, he became emotionally distressed and developed a generalized tonic–clonic seizure, followed by recurrent seizures and apnea. A care team, including medical students, residents, nurses, pharmacists, and attending physicians, provided continuous monitoring and supportive management with airway protection, bag-valve-mask ventilation, intravenous access, and dextrose-containing fluids. No antiepileptic medications or diagnostic tools were available. The patient experienced prolonged seizure activity with recurrent respiratory arrest, suspected to represent ictal central apnea. Oxygen saturation dropped to 73% but stabilized above 92% with sustained ventilation. Emergency care continued for over 45 minutes until transfer by emergency medical services. He was later hospitalized and discharged without neurologic deficits. This case highlights the clinical and logistical challenges of managing seizure emergencies in resource-limited environments, underscoring the lifesaving potential of rapid, coordinated interdisciplinary action. Even without access to pharmacologic therapy or advanced diagnostics, effective teamwork and decisive supportive care proved critical. Furthermore, this experience illustrates the educational value of global health initiatives like PWH, which foster adaptability, critical thinking, and collaboration. Pre-trip training in emergency protocols, including seizure management, is essential for optimizing patient outcomes in similar contexts.
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Copyright (c) 2026 Mónika Domenech Acevedo, Wid Alhassani, Blake DePaul, Michael Niederbrach, David Boughanem, Ava Bruner, Aiden Jaskolka Brown, Eduardo Gonzalez (Author)
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