# Status epilepticus



## Austin carawan (Feb 2, 2016)

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


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## Chewy20 (Feb 2, 2016)




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## Jim37F (Feb 2, 2016)

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


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## Austin carawan (Feb 2, 2016)

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.


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## Austin carawan (Feb 2, 2016)

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


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## ERDoc (Feb 2, 2016)

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


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## Austin carawan (Feb 2, 2016)

Fair enough!


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## CALEMT (Feb 2, 2016)

Austin carawan said:


> Fair enough!



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


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## Austin carawan (Feb 2, 2016)

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


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## CALEMT (Feb 2, 2016)

Austin carawan said:


> 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.


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## Austin carawan (Feb 2, 2016)

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


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## RedAirplane (Feb 3, 2016)

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

Although in status I would be concerned about breathing.


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## gotbeerz001 (Feb 3, 2016)

RedAirplane said:


> 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.


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## gotbeerz001 (Feb 3, 2016)

Double post


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## Bullets (Feb 3, 2016)

RedAirplane said:


> 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


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## wilderness911 (Feb 7, 2016)

gotshirtz001 said:


> 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.


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## ParamedicStudent (Feb 7, 2016)

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.


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## Gurby (Feb 7, 2016)

ParamedicStudent said:


> 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"


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## NomadicMedic (Feb 7, 2016)

Bullets said:


> 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.


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## SpecialK (Feb 7, 2016)

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.


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## ParamedicStudent (Feb 13, 2016)

Gurby said:


> 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:
> 
> 
> 
> ...


Are you the real captain Kirk?


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## Gurby (Feb 14, 2016)

ParamedicStudent said:


> Are you the real captain Kirk?



No, he has much better hair.


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## EMT533 (Feb 16, 2016)

If someone is in status epilepticus give them O2. Do NOT restrain them or place anything in their mouth.  Roll them onto their side and allow them continue to seize. Keep the patient from injuring themselves and time the seizure. If the patient stays on their back their tongue may occlude the airway. They may vomit as well that is why the patient needs to stay sideways. Yes, they bite their tongue and cheek and they bleed. The reason they stop breathing is the diaphragm is a muscle and tonic- clonic seizures involve the muscles so if the arms lock up and release then the diaphragm will too. if the patient's diaphragm is locked up the lungs cannot fully inflate. That is why you do not bag the patient. Give them oxygen.

 Let the seizure happen if the patient HAS a hx of seizures.
STOP IT: 
         -if it lasts more than 5 minutes
.        -Another seizure occurs before the patient comes out of the postictal stage  

If the seizure stops on it's own and the patient isn't responding with minimal comprehension around 5 minutes during the postictal stage there               is possible brain damage.

       If the patient has no history of epilepsy or is PREGNANT STOP it ASAP

Postictal Stage:           

  *Ask them to give 2 fingers
      *Say their name
            *Squeeze your hand


The most common times a pt. has seizures without a previous history of epilepsy are:

-Mixing medication with alcohol
-overexertion
-drugs
-drug OD
-heat stroke
-fever
-dehydration
-mixing prescription medication with over the counter medication without consulting with a physician
-mixing prescription medication with herbal substitutes


Also, talk to the patient during the seizure, they can hear on and off throughout the episode . 
I have heard many stories from my teen advocates about times they woke up in ambulances embarrassed. What I learned from them was kindness and not pity and from the adults was to move on. It is frightening for the little kids, embarrassing for the teens and early twenty year olds, and annoying for the adults. 

I am a certified Hope Mentor as well as Epilepsy Educator for the South Central Texas Epilepsy Foundation. 
I was also the 2012 SC Texas Epilepsy Foundation Advocate in 2012. 
I have taught many epilepsy safety classes as well awareness classes for high school students as well as advocated for the foundation in D.C. 

If you have any questions please message me. If I don't know the answer I have people that do.


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## Tigger (Feb 17, 2016)

EMT533 said:


> If someone is in status epilepticus give them O2. Do NOT restrain them or place anything in their mouth.  Roll them onto their side and allow them continue to seize. Keep the patient from injuring themselves and time the seizure. If the patient stays on their back their tongue may occlude the airway. They may vomit as well that is why the patient needs to stay sideways. Yes, they bite their tongue and cheek and they bleed. The reason they stop breathing is the diaphragm is a muscle and tonic- clonic seizures involve the muscles so if the arms lock up and release then the diaphragm will too. if the patient's diaphragm is locked up the lungs cannot fully inflate. That is why you do not bag the patient. Give them oxygen.


If the patient is not ventilating during a seizure, oxygen therapy is not going to help. Ventilation, while difficult, is what is needed. We are not going to leave a seizing patient who is not responding to medication in apneic state.


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## EMT533 (Feb 17, 2016)

The reasoning behind the oxygen flow is when they do take a breath they get as much oxygen as they can. Here is the website for the Epilepsy Foundation that I advocate for.

http://www.epilepsy.com/start-here/seizure-first-aid


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## CALEMT (Feb 17, 2016)

Tigger said:


> If the patient is not ventilating during a seizure, oxygen therapy is not going to help. Ventilation, while difficult, is what is needed. We are not going to leave a seizing patient who is not responding to medication in apneic state.



This. Plus with your theory by placing the patient on high flow 02 if he is apneic for 3 minutes during his seizure then you've just starved the brain of oxygen for 3 minutes. I don't get why this is difficult to understand, its the basics where everyone that goes through a healthcare provider class is taught. No breathing=BVM simple as that. You don't have a patient if they're not breathing, you have a body. Granted ventilation with a BVM is difficult enough to do on a non seizing patient (i.e. getting a good seal) but it shouldn't be an excuse to not preform essential treatment.


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## EMT533 (Feb 17, 2016)

http://www.epilepsy.com/start-here/seizure-first-aid

This is the website of the epilepsy foundation I advocate for.


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## EMT533 (Feb 17, 2016)

People do not die from seizures themselves. Brain damage from seizures occurs from the over stimulation of neurons misfiring for an extended period of time. That is the concern. That is why it is important to time the seizure as well as the postictal stage.


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## CALEMT (Feb 17, 2016)

EMT533 said:


> People do not  die from seizures themselves. Brain damage from seizures occurs from the over stimulation of neurons misfiring for an extended period of time. That is the concern. That is why it is important to time the seizure as well as the postictal stage.



Thank you for the lesson, but I am well aware that people don't die from seizures (regularly). I am also aware that brain damage in seizure patients occurs from over stimulation of the neurons. But I'm still struggling to understand the reasoning to not bag someone who isn't breathing?

The website you provided doesn't apply here. I read the article and noticed on several occasions the bullet point "Call 911 if". Okay... I am 911, what now? This isn't geared toward healthcare providers. This is geared toward normal people with no medical training whatsoever.

Plus and this is me website profiling, but I don't really trust any .com website that gives "medical advice". Sorry, but thats just me. Every EMT book you look in will pretty much say the same thing: If breathing is inadequate or absent reposition the airway, if breathing still inadequate or absent insert airway adjunct (NPA) and provide positive pressure ventilation with 02 (i.e. BVM). If patient is breathing adequate, place on supplemental 02 via NRB at 15lpm.


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## EMT533 (Feb 17, 2016)

I apologize my statement is incorrect. People do die, but it is uncommon. I am assuming I will get grief for that later. If a patient is completely apnic. Then they must not be seizing. I have not heard of an epileptic becoming apnic. The only way that I can think a patient can become apnic is if the seizure is finished. If this is the period of time they are apnic then of corse you follow protocol. But giving a patient oxygen during a seizure is beneficial.


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## EMT533 (Feb 17, 2016)

Course* And always do whatever is best for the patient! No problem for the information.


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## Gurby (Feb 17, 2016)

EMT533 said:


> If a patient is completely apnic. Then they must not be seizing.


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## Tigger (Feb 18, 2016)

Seizure patients can certainly suffer anoxic brain injuries from poor ventilation. They may be breathing but it is not always effective.

Off-topic posts have been removed.


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