scubanurse Posted September 25, 2013 Posted September 25, 2013 Diazepam 10mg IV Any way to count pills? Sounds like INH overdose with the seizing and tachycardia. Can we RSI sedate and transport? I'm guessing ems doesn't carry B6/Pyridoxine which I believe is the antedote for isoniazid. Fluids, oxygen therapy and transport? Diazepam/sedation with intubation can help stop/prevent status epileptic us from occurring. But then again I am frequently wrong.
chbare Posted September 25, 2013 Author Posted September 25, 2013 You can't make heads or tails of his bottles and pill counts. Following diazepam administration, the seizures continue. What to do?
uglyEMT Posted September 25, 2013 Posted September 25, 2013 This is now on the ALS side of things, I will transfer care to my Medic and assist. Had to look up the meds, concur on the possible TB. N95s and notify Dept of Health for possible exposure. Have dispatch call ahead to the ED and let them know as well, possible isolation procedures upon arrival.
chbare Posted September 25, 2013 Author Posted September 25, 2013 Noted. The patient continues to experience tonic-clonic activity that is seemingly unresponsive to the diazepam.
scubanurse Posted September 25, 2013 Posted September 25, 2013 Any response with vecuronium or succs? Do the seizures respond to RSI?
chbare Posted September 25, 2013 Author Posted September 25, 2013 How would you know if the seizures were controlled once paralytic agents are administered?
scubanurse Posted September 25, 2013 Posted September 25, 2013 You wouldn't, but continuous tonic/clonic seizures with no secured airway is going to get you a very hypoxic patient. Couldn't a paralytic help in controlling the airway until arrival in the ER and more treatment options.
Just Plain Ruff Posted September 25, 2013 Posted September 25, 2013 What is his skin color? Could he have a liver issue causing his problem?
chbare Posted September 25, 2013 Author Posted September 25, 2013 Let us say we do not have access to RSI. A specific treatment has been mentioned, but I want to spend some time discussing the seizure issue before moving on. Do you guys expect benzodiazepines to work with this patient? Why or why not? What is the pathophysiology of the suspected problem?
scubanurse Posted September 25, 2013 Posted September 25, 2013 INH seizures won't usually respond to benzodiazepines, but they are worth a shot, since it's not 100% known that this is INH toxicity causing the seizure activity. The fact that the seizures aren't responding to valium is pointing in the direction of toxicity. INH can cause refractory seizures by creating a GABA deficiency I believe. GABA is a neurotransmitter so a deficiency in this can lead to neuro symptoms such as refractory seizures. But now my brain hurts and I'm heading to bed.
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