Tx of seizures in the acute head injury

[donedeal]

What is your treatment plan/protocols for grand mal seizure secondary to head injury? What is the physiology behind why benzos may be contraindicated in this scenario?

[usalsfyre]

Homework or something else?

[Richard B the EMT]

As a BLS provider, cushion the head against injury during Tonic/Clonic, immobilize to best of ability and protocols, and transport to Trauma Center.

[donedeal]

No homework...just reading my protocols again. We call for medical control if we want to tx the seizure in the acute head injury patient. Just want a little more information on why that is....

[Doczilla]

I can't think of any reason that benzos would be contraindicated in that setting. You don't want to drop their pressure too much if their ICP is up, and snowing them with too much drug will confound the neuro exam, but both of these concerns are a distant second in the patient who is actively seizing.

'zilla

[usalsfyre]

Doczilla covered it before I could. The only thing I could think of was concern over potential hemodynamic instability.

[Asysin2leads]

Acute alcohol intoxication is the only contraindication/caution I've ever found for benzos in seizing head injury patient.

[Bieber]

I believe we have to call for benzos for head injuries too, though I'm not sure. Technically we can use two protocols as appropriate, but they are extremely fussy about us doing pretty much anything besides an IV and fluid therapy as indicated for multisystems trauma. No pain management, no nausea control, etc, etc. I've only ever had two head injuries so far, and neither of them seized on me.

[MedicAsh]

Our protocols dont address this directly but according to my medical director you treat the seizure as you would treat any other seizure. The one main thing you want to be careful of is the patient's respirations. If they are showing signs of cushings triad this is when you really want to watch the airway and consider intubation. He also said that in a situation like this unless specifically stated in your standing orders, to contact medical control. It saves your ass and its always a good idea to ask when you are unsure of something. Our medical control here is great about us calling if we are unsure.

[tcripp]

Made me go review our guidelines...and nothing specific to a head trauma / seizing patient. But, I'd expect RSI in the near future depending on the details which would allow for lidocaine to help with potential ICP rise.