Management of the seizure patient

[fiznat]

I don't see a problem with scooping up a seizing patient and running with him. Especially for BLS providers, who I think as a general rule should never just wait on scene for a patient to stop convulsing.

What exactly is the issue we're discussing here?

[dahlio]

What exactly is the issue we're discussing here?

Don't think it's so much of an issue, rather situational thinking. Sounds like we're just giving experiences on seizure calls, and kind of showing what to do in certain instances.

[under-dreaming]

Thanks, everybody.

[Dustdevil]

ERDoc, of course, answered your question as best as can be done. As for the EMT you work with, I won't argue his competence, as I don't know him and you do. But I don't see anything particularly wrong with his management of this patient. Exactly what kind of vitals do you expect to get from an actively, grand mal seizing patient? Slim to none. And you have no EKG, I assume, which would be one of the few "vitals" I would actually need, to assure that the seizure was not cardiac in origin (although this is not likely). The other would be a D-stick, but again, you probably have no means to treat the results, so it's a moot point. Hopefully, your partner is familiar with the history on the patient, significantly shortening his diagnostic time. So, for this guy -- and if it can safely be done -- getting off the scene and on the road is probably the best medicine.

Like bleeding, all seizing eventually stops.

[under-dreaming]

Thanks, Dustdevil. The EMT was able to get an IV started when we parked at the hospital. The pt. convulsions range from moderate to severe... kind of like ocean waves. BP, P, SpO2: those could have been gotten easily in my opinion... glucose check too. You may be right, pertaining to interventions from the findings of the V/S. However, I don't like making a hospital radio report and/or face to face report when I can't even tell them any useful information. It might as well have been the family dropping him off in the ER. In a small town, reputations for cutting corners can develop quickly... you know what I mean?

[under-dreaming]

for BLS providers, who I think as a general rule should never just wait on scene for a patient to stop convulsing.

That's what I thought too. My BLS textbook says to remove surrounding objects, place something soft under the pt. head, monitor airway, possible O2 application, and then transport when the pt. stops convulsing.

It was an extremely vague section in the chapter regarding pt. with ALOC. I really just needed to see what the people in this business really do. You know how it goes. Thanks for your input.

[Fox800]

BP, P, SpO2: those could have been gotten easily in my opinion... glucose check too.

Pulse...maybe. HR and SpO2 by finger probe? Sure. Blood glucose level test? That's expected...the standard of care. BP? Very funny. Try getting an accurate auscultated BP on an actively seizing patient. Tell me that heartbeat you felt wasn't his arm flailing around. And don't tell me that the NIBP your monitor gives you would be accurate.

As a BLS provider, the fact that there's not much you can do makes this situation pretty straightforward and easy. He's been seizing for 20+ minutes prior to EMS arrival, so he's hypoxic as all get out. NPA, BVM @ 15LPM, whatever initial vitals you can get, backboard, prompt ride to the hospital.

[HellsBells]

That's what I thought too. My BLS textbook says to remove surrounding objects, place something soft under the pt. head, monitor airway, possible O2 application, and then transport when the pt. stops convulsing.

Thats wonderful advice if the seizure is lasting 3-5 min, but a sustained grand mal seizure lasting for 20 min requires some sort of intervention. Think about the physiological process in an actively seizing patient, how much oxygen do you think he is getting if there is a seizure lasting for 20 min? What effect could this hypoxia possibly have on his future brain function? Do you think he will get better oxygenation with the O2 you are trying to give him as he seizes, or at the hospital where he can receive medication to stop the seizure. These are questions you should ask yourself to guide your treatment.

[Fox800]

This patient needs benzodiazepines and may very well have paralytics and an ET tube on the horizon. None of which you can do at the BLS level.

[tniuqs]

Thats wonderful advice if the seizure is lasting 3-5 min, but a sustained grand mal seizure lasting for 20 min requires some sort of intervention. Think about the physiological process in an actively seizing patient, how much oxygen do you think he is getting if there is a seizure lasting for 20 min? What effect could this hypoxia possibly have on his future brain function? Do you think he will get better oxygenation with the O2 you are trying to give him as he seizes, or at the hospital where he can receive medication to stop the seizure. These are questions you should ask yourself to guide your treatment.

I like the way you think, in the majority of cases self limiting even jacksonian.

At the bls level support any attempts to breath and support, oxygenation being paramount, watch the duck valve on BVM.

ALS benzos, the consider ETI, sux, benzos plus narcs, consider cause .... ,ie ETOH ... then Thiamine prior to D50, little think called

http://en.wikipedia.org/wiki/Wernicke-Korsakoff_syndrome

cheers