AZCEP Posted March 25, 2007 Posted March 25, 2007 Rectal valium to end the seizure, unless it abates quickly. Out comes the Broselow tape, and a dose of Narcan. Vascular access would be a good idea at this point, and a BGL. My guess is this is a DM exposure so I'm not going to expect great results from the Narcan. Just for the information, what size were the pupils?
chbare Posted March 25, 2007 Author Posted March 25, 2007 The parents are screaming in fright. The patient continues to seize after 1 minute. You take the standard seizure precautions and position the airway to the best of your abilities. IV access is established and 0.12 mg of narcan is administered IVP. (Estimated pt weight at 12 kg) During the procedure your partner administers a dose of rectal Diazepam. The patient continues to seize following your interventions. The pupils were about 4 mm bilat and slightly sluggish to react. Take care, chbare.
AZCEP Posted March 25, 2007 Posted March 25, 2007 Got to stop the seizure. Kiddo is already hypoxic, and having neuro issues. Could probably use some sugar, particularly following the seizure. All the tools come out for this one. SpO2/EtCO2/ECG/possibly a vent.
chbare Posted March 25, 2007 Author Posted March 25, 2007 You have all of the ALS interventions at your disposal to care for the kiddo. SpO2 reads 88%, ETCO2 reads 50, and you note sinus tachycardia at a rate of 110 with an occasional unifocal PVC on the monitor. Take care, chbare.
AZCEP Posted March 25, 2007 Posted March 25, 2007 Any changes following the Narcan/Diazepam? Can we get a blood sugar? While we are doing things, let's get a blood pressure. It's not terribly important, but might give a clue as to what is happening. How about we rule some things out here. Not --anticholinergics: pale skin, afebrile --sedative/muscle relaxants: seizure is unlikely Maybe --opioid receptor agonists, including dextromethorphan: pale, hypoventilating, bradycardic --beta blockers: vitals in the toilet --calcium channel blockers: bradycardia. This is a bit of a reach, but still a possibility --hypoglycemics: don't know what the BGL is yet
chbare Posted March 25, 2007 Author Posted March 25, 2007 No changes following the prior interventions. BGL is 112 mg/dl. B/P is 58/30. No changes following glucagon administration. Take care, chbare.
AZCEP Posted March 25, 2007 Posted March 25, 2007 Who said anything about glucagon? I think it was a consideration for the possibility of a beta blocker ingestion, but I didn't think we had used it. Heart rate slow, blood pressure well below acceptable, any response to the Narcan?
chbare Posted March 25, 2007 Author Posted March 25, 2007 A prior poster wanted an order for glucagon from med control. Typo on my part. The patient does not improve following the narcan. We do not have to give glucagon, just note that if we did, the patient would not improve. Take care, chbare.
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