Management of the seizure patient

[under-dreaming]

There is really no reason to backboard this patient, unless the fell and suffered trauma during the seizure, since this is a known seizure patient (it would be different if he had no history of seizures, or you had no idea what his history is). In this BLS scenario, with you knowing that this patient does tend to have seizures for greater than 20 minutes, I would load and go to the hospital (starting an IV, placing him on highflow O2, and maintaining his airway enroute).

It is a very simple algorithm to follow. Thats what bugs me about this other technician, laziness. The backboard has to do with the stairs we have to bring him down every time. Pretty much every house here has some type of elevation that we have to deal with.

**Right, I didn't realize I wrote in the question that it is normal to put the pt. on a backboard... my mistake.**

[dahlio]

Waiting is not always the best thing to do. I once had a pediatric seizure patient, who didn't stop seizing the 7 minutes we were on scene, and the 20 minute ride to the hospital. At that point it was a carry him, strap him as best we can, and intercept with ALS. (This patient was also hot to the touch, and cooling didn't work to well.) ALS pushed a variety of drugs, but he didn't stop convulsing even in the Pediatric ER. This kid did had some type of disease (can't remember, was long ago), and the only thing he had going for him was the fact he had a trach stoma, making it easier for us to breath for him. Waiting would have had worse consequences, and we would have been on scene way too long. It all depends.

[under-dreaming]

Waiting is not always the best thing to do. I once had a pediatric seizure patient, who didn't stop seizing the 7 minutes we were on scene, and the 20 minute ride to the hospital. At that point it was a carry him, strap him as best we can, and intercept with ALS. (This patient was also hot to the touch, and cooling didn't work to well.) ALS pushed a variety of drugs, but he didn't stop convulsing even in the Pediatric ER. This kid did had some type of disease (can't remember, was long ago), and the only thing he had going for him was the fact he had a trach stoma, making it easier for us to breath for him. Waiting would have had worse consequences, and we would have been on scene way too long. It all depends.

Thanks. Apparently we have to remain open to adaptation (as usual). And that's what I initially considered to be the case. It helps to hear stories of application. I appreciate your time.

[Happiness]

m worst case was a 40yr old who has nine lives (original injury was tramatic,,Pt was riding dirt bike with a friend who was a medic and went over a small hill and boom hit a tree. the branch when through his helmet shield, through his eye socket and into his brain) He is compliant with all his meds and takes very good care of himself. He once in awhile has grand mal and we are off to the races. We go in get the airway secure (we watch and wait for that spit sec of relaxation and in goes an airway) we start bagging and pink him up a bit, then we strap him down on the clam shell or scoop and off we go asap. We tend to wait until the the event slows down a bit and then load. With every patient there will be a different senerio and you will have to learn what they are. I personally will not move a pt unless it is safe to do so, but in this case it was a load and go in others we can wait. In the end of this call we medivac this pt out and his siezure lasted for 18 hrs until he made it to a bigger hospital. Everytime he was given lower doses of the drugs he would sieze again. After about 3 weeks the drs told the wife that he should be taken off of life support and let nature take its course. she said please try one more time and he is now walking around with about 4 more lives to go.

[under-dreaming]

Good story, Happiness. Thanks.

[ambodriver]

Management of the actively seizing pt. should always start with a trumpet and O2---then control of the seizure!

and someone seizing for 20 mins-----thats a long long time to be seizing.

Either the pt. was faking---or something funny is going on----there is strong potential for serious hypoxia and death with a seizure lasting that long. Yikes

[akroeze]

Management of the actively seizing pt. should always start with a trumpet

I personally start all my patient encounters with a tuba but a trumpet I guess would work in a pinch.

[fireflymedic]

I don't particularly care for the insinuation there. There are patients that frequently cluster and/or go into status due to simply the nature of their type of epilepsy (there is more than one type). Agreed though that 20 min is WAAAAY too long for them to be going without some type of intervention. My call? I'd go with IM injection of 2 mg ativan or 10mg of versed to get things stopped (don't waste the time with trying to get a line in a seizing patient). Throw in a nasal trumpet as you are right around the corner from the hospital I wouldn't blow time intubating the patient as chances are you'll have to go nasal or RSI to get the airway and you'd spend more time getting it than you would being at the hospital where things are more optimal to get the airway. Especially with your limited resources. We don't RSI here unless we've got two als providers at medic level one of which being critical care. So here's my take.

Give the ativan/versed (drug of choice here), nasal trumpet, board 'em, get the heck outta there. From there, in the truck, get a line if you can, give additional meds if needed enroute and make use of what you've got. Suction as needed, protect from injury and go from there. If things are really bad, go for the tube if truly needed, but otherwise do it in more optimum conditions of the ER. Especially if you anticipate a difficult airway (chances are though 20 min seizing, they're going to end up winning intubation in the ER if still going as ventilation will not be adequate to sustain life). Hope this helps you and sorry you are put in that situation. It's never fun, fortunately you are close to ER though.

[akroeze]

It bears mentioning that we're assuming a glucometer check was done.

[ambodriver]

It bears mentioning that we're assuming a glucometer check was done.

lol! So true!