# Those tiring/really bad calls...



## traumaluv2011 (Aug 29, 2011)

So far, my worst call is a seizure patient who had five seizures lasting about 3 minutes while he was in our care. It was a fun time trying to give him in IV when he was flailing about. We had him in a Reeves stretcher, but we didn't secure the arms so medics would have access. It would have been much easier with an IO, but they don't carry them. So we had three EMTs and one medic in the back of an ambulance trying to hold this guy down. And he was winning. 

The medic finally was able to push ativan and the guy starting coming back to consciousness when we finally got to the hospital.


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## usafmedic45 (Aug 30, 2011)

> The medic finally was able to push ativan and the guy starting coming back to consciousness when we finally got to the hospital.



IM, IN, PR?  I would not have let the lack of a line stop me from getting benzos into this guy.


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## DESERTDOC (Aug 30, 2011)

Midazolam IN, IM?


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## Handsome Robb (Aug 30, 2011)

DESERTDOC said:


> Midazolam IN, IM?



It's water-based not oil-based like diazepam so why not?


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## usafmedic45 (Aug 30, 2011)

DESERTDOC said:


> Midazolam IN, IM?



I think you mention that as a suggestion not, as a question, right? 

The discussion mentioned Ativan (lorazepam) but Versed (midazolam) is another option even though it is a piss poor anticonvulsant so far as I am concerned compared to others in its family.


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## abckidsmom (Aug 30, 2011)

usafmedic45 said:


> I think you mention that as a suggestion not, as a question, right?
> 
> The discussion mentioned Ativan (lorazepam) but Versed (midazolam) is another option even though it is a piss poor anticonvulsant so far as I am concerned compared to others in its family.



Given the choice, would you go with versed or Valium for active seizures?  Those are our benzos cause we aren't going to be carrying ativan for whatever reason.


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## MrBrown (Aug 30, 2011)

Midazolam wins out with its faster onset time.

We have it IM, IN, IV and IO. 

Back in the day (up until the late 1990s) PR stesolid (diazepam) was carried here


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## usafmedic45 (Aug 30, 2011)

abckidsmom said:


> Given the choice, would you go with versed or Valium for active seizures?  Those are our benzos cause we aren't going to be carrying ativan for whatever reason.


If I had an IV or IO, diazepam.  If not, midazolam.  Versed might be quicker onset but it's not as effective at suppressing seizure activity in my experience.  Honestly, my benzo of choice is lorazepam for this sort of thing with Versed being held in reserve for RSI, etc.


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## abckidsmom (Aug 30, 2011)

usafmedic45 said:


> If I had an IV or IO, diazepam.  If not, midazolam.  Versed might be quicker onset but it's not as effective at suppressing seizure activity in my experience.  Honestly, my benzo of choice is lorazepam for this sort of thing with Versed being held in reserve for RSI, etc.



They decided against stocking ativan in our system because there is no means for refrigeration and it would expire so often outside of the fridge.

ETA:  I totally agree that versed and valium are neither one a totally ideal choice.  Fortunately, we very rarely see active seizures.


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## traumaluv2011 (Aug 30, 2011)

I am not a medic. So this talk about medicines is kinda iffy for me. I've heard about all of those, but I don't know too much about them. The medic did what he did and it seemed to work. We got to the hospital fine and the guy was alive and conscious. Although he had amnesia, which I believe is a side effect of the Ativan.


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## usafmedic45 (Aug 30, 2011)

> Although he had amnesia, which I believe is a side effect of the Ativan.



It's also an effect of generalized seizures.  The patient isn't conscious in most cases that EMS personnel could identify as being a seizure.


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## traumaluv2011 (Aug 30, 2011)

He was not conscious until we got to the hospital. The medics administered ativan en route to the hospital.


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## usafmedic45 (Aug 30, 2011)

traumaluv2011 said:


> He was not conscious until we got to the hospital. The medics administered ativan en route to the hospital.



That would explain the amnesia right there then, wouldn't it? :glare:


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## Shishkabob (Aug 30, 2011)

I tend to give Versed IN instead of Ativan. 

I'm not a fan of playing with pointy needles next to someone flailing about.


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## usafmedic45 (Aug 30, 2011)

Linuss said:


> I tend to give Versed IN instead of Ativan.
> 
> I'm not a fan of playing with pointy needles next to someone flailing about.



I'll take the small risk of a needle in exchange for better control of the condition.


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## usalsfyre (Aug 30, 2011)

I prefer midaz IN over lorazepam for onset time. Lorazepam seemingly takes forever and a day to work IM.

The problem I've had with midazolam is not initial control of the seizures, it just seems like due to the fact it has a short duration anyway your patients on Dilantin chew through it like a Cajun at an all-you-can eat crawfish shack...


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## usafmedic45 (Aug 30, 2011)

> The problem I've had with midazolam is not initial control of the seizures, it just seems like due to the fact it has a short duration anyway your patients on Dilantin chew through it like a Cajun at an all-you-can eat crawfish shack...



Exactly.  That's what makes it such a piss poor choice for seizure control.


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## Epi-do (Aug 30, 2011)

The only benzo we carry is midazolam, so which one to choose is a pretty easy decision for me.  The couple times I have had to give it, the initial dose was given IN.  That gives me a chance to pop the IV in without the pt flailing about, and I can use it if I need to give any additional doses.  So far, I haven't ever had to give more than one dose.


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