Status epilepticus

[Austin carawan]

not sure if this is possible, or even advised, but patient in status epilepticus, while waiting for als, do you just protect airway, even if patient is not breathing at times, or can you bvm this patient with supplemental 02? I would think that may be difficult

 

[Chewy20]

 

[Jim37F]

If you have a patient that stops breathing, why would you NOT want to start BVM'ing? (Besides obvious signs of death/DNRs etc)

 

[Austin carawan]

Am I way off? One of the optional answers was bag them and I've torn the Internet apart with no definite answer. By your emoji, not choosing that must've been the right choice.

 

[Austin carawan]

, I just know it said not breathing at times, I figured they meant irregular respirations.

 

[ERDoc]

Real pts do not fit multiple choice questions. If they are not breathing adequately, you bag them.

 

[Austin carawan]

Fair enough!

 

[CALEMT]

Fair enough!

Should be simple enough. No breathing=BVM on high flow O2.

 

[Austin carawan]

Agreed, I think I'm just overthinking these questions way too much...

 

[CALEMT]

Agreed, I think I'm just overthinking these questions way too much...

When in doubt A,B,C. Is his airway open and patent? Yes, cool next or No, maybe I should reposition. Is he breathing? Yes, cool or No, maybe I should bag. Does he have a pulse? Yes, cool or No, maybe I should start CPR.

 

[Austin carawan]

I screen shot that. Very helpful way to look at it. And then if abcs are managed then you move on to your patient assessment. Thank you kindly

 

[RedAirplane]

I thought you weren't supposed to touch seizing patients?

Although in status I would be concerned about breathing.

 

[gotbeerz001]

I thought you weren't supposed to touch seizing patients?

Although in status I would be concerned about breathing.

You're supposed to limit the amount of harm done due to seizure activity; unfortunately, many people simply learned "do not touch" which can also be harmful based on the scenario.

You will find that all things in EMS are simply risk vs gain; it is your job to properly assess the situation and make a treatment plan within your scope. If you understand what is going on, can identify the probabilities of inaction and act (justifiably) as a pt advocate, you will be fine.

 

[gotbeerz001]

Double post

 

[Bullets]

I thought you weren't supposed to touch seizing patients?

Although in status I would be concerned about breathing.

Nah man, youre supposed to put a spoon in their mouth and throw cold water on them

 

[wilderness911]

You're supposed to limit the amount of harm done due to seizure activity; unfortunately, many people simply learned "do not touch" which can also be harmful based on the scenario.

You will find that all things in EMS are simply risk vs gain; it is your job to properly assess the situation and make a treatment plan within your scope. If you understand what is going on, can identify the probabilities of inaction and act (justifiably) as a pt advocate, you will be fine.

Right on the money.

 

[ParamedicStudent]

If you feel like you can't do something effectively, you just have to do the best you can. I might consider c-spine precautions if they hit their head or injured themselves, and prevent them from hitting their head on the ground. Possibly provide cushion like a blanket or pillow between their head and ground if possible. After that, get the bvm and ventilate the best you can.

 

[Gurby]

If you feel like you can't do something effectively, you just have to do the best you can. I might consider c-spine precautions if they hit their head or injured themselves, and prevent them from hitting their head on the ground. Possibly provide cushion like a blanket or pillow between their head and ground if possible. After that, get the bvm and ventilate the best you can.

You're right, and the best you can do is the best you can do.... And I suppose this is an unhealthy thought for me to have... but I immediately thought of this:

"Sir, it's just that you're incompetent, sir"
"I'm doing the best I can"
"Sir, it's not good enough"

 

[NomadicMedic]

Nah man, youre supposed to put a spoon in their mouth and throw cold water on them

Ice down the pants? Oh wait ... That's for heroin ODs.

I touch seizure patients all the time. To squirt Versed up their nose or to start a line. Most status seizure patients aren't totally doing the funky chicken across the floor. And if they are, move the stuff that will smash their melon when the hit it.

Oh and yeah, if they stop breathing, bag them. Nasal airways work pretty well in SZ Patients.

 

[SpecialK]

Put reservoir oxygen on and give them a big slug of midazolam and most settle down quite nicely.

As an aside, we no longer have intranasal midazolam, it wasn't working well, so the new approach is a 10 mg bolus IM repeated once if needed or up to three boluses of 5 mg IV midazolam.

The CPGs are currently under review and I'd put $20 on IV midazolam being given to Paramedics and IM midazolam given to EMTs. I don't see the point of a double EMT (or EMT/EMA) crew turning up to somebody fitting and not being able to do anything about it.