IN treatment of seizures

[Ridryder 911]

It would appear we may need to have a refresher on pharmacology and maybe seizures. Look at what medications terminate seizures, and those that relaxes the muscles. Much different actions.

Now, why would one want to chase a vein when you can spray IN Versed and terminate the seizure, after you had performed a FSBS to rule out the etiology? Stop the process, if it appears it a continous and status. The initial comment was on status seizure activity, why continue to prolong? Repeated studies have demonstrated IN route works as fast and in some fster than IV route on Versed.

As well, my seizure patients may get a NP. Yeah, its called an airway. No it's not invasive and I have yet not seen one yet that did not have large amount of nasal & oral secretions. When they become post-ictal, simply remove, no problem. Chances are they will never know they had it.

Cmon, this is not a chicken or the egg debate.

R/r 911

[fireflymedic]

Well put RR911. I'm a big fan of NPA's as well (as you can tell from prior posts). I don't see the need to prolong seizure activity nor chase a vein in a seizing patient. Is why in this area they are pursuing doing an IM versed as opposed to IV ativan, in addition to the fact we have the ability to use IN. With use of MAD - I really don't see the reason to chase a vein. It's not easy getting an IV in an actively seizing patient, so I definitely see the benefit to going IN over any other route. Remember it is the same mucuous membrane absorbtion as with peds going rectally. Never mind many of your frequent seizure patients also have home diastat (rectal valium gel) in case of status epilepticus or clustered seizures. If we remember correctly, absorbtion through the mucous membrane is the second fastest method, so perhaps we should be thinking in terms of quickest absorbtion as opposed to what we are trained like monkeys to do. Just something to consider IMHO. Stay safe.

Also, RR - I was referring to a post intubation care. Versed is going to carry your anti seizure properties. Diprivan doesn't as much and used more for sedation, though I've frequently seen patients that were refractory put on diprivan drips in an attempt to slow their brain down enough to chill out. Just a fun afterthought.