# 4YO Partial Siezure



## emtCstock (Jan 5, 2012)

I'm an emt-b and this happened recently

 (I currently work at this store awaiting a job for the ambulance service in my county, so I have only put an honest 24 hours in the field so I'm not used to real life scenes yet)

So a 4 year old at the store is sitting in the cart seat and starts to show signs of a partial seizure and signs of AMS. If his breathing is adequate and chest rise is bilateral. He wasn't having body spasms but just more of finger spasms and the common eye rolls. When his mother called 911 they said place him on his right side. 

Would you say that's how you would manage his airway until ems arrived?

Are you able to place in neutral and hyper extend the neck?

I know i'll learn as I experience situations more, but I feel this should have been an easy one for me.


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## emtCstock (Jan 5, 2012)

Also not sure why the 911 dispatch said right side rather than the left, not sure if that makes a difference or not.


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## fast65 (Jan 5, 2012)

To manage the airway in this child I would say to place him on his side. In the case that he vomits, it will help prevent him from aspirating. As far as left vs right side, it makes no difference, at least to the best of my knowledge.


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## emtCstock (Jan 5, 2012)

Okay right on. It just made me wonder why I wasn't sure to do, maybe because ive never been on a call of a ped with a seizure. Not sure, I was calm but just puzzled.


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## mycrofft (Jan 5, 2012)

Rt side is often cited as preferable because many people are more comfortable on that side, maybe because that puts heart on top of greater mass of lungs?
Are we talking about an asymmetrical presentation of symptoms? Like a focal seizure?


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## emtCstock (Jan 5, 2012)

Yes, focal.


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## emt brando (Feb 7, 2012)

i would say left lateral recumbent position


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## themooingdawg (Feb 11, 2012)

the only real main thing that you're concerned about this kid is the possible chance that he might develop into a tonic clonic seizure; therefore, the best thing to do before EMS arrived would be try to isolate him and like the dispatcher said, have him on his side just in case he vomits in order to protect his airway from aspiration


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## emtCstock (Feb 11, 2012)

Yeah I had him on his side. I was just curious if there was any different between left Lat. recumb, or the right side like the dispatch said.


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## Maine iac (Feb 11, 2012)

Left lateral recumbent because most cots are either in the center of a two bench ambulance or on the drivers side, in which case you don't want the pt. facing the wall, so you have them on their left side facing you.


Right?


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## ffemt8978 (Feb 11, 2012)

Maine iac said:


> Left lateral recumbent because most cots are either in the center of a two bench ambulance or on the drivers side, in which case you don't want the pt. facing the wall, so you have them on their left side facing you.
> 
> 
> Right?



Depends upon if they brushed their teeth today.  :rofl:


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## Bruiser (Feb 11, 2012)

LLR due to the position of the gastric and antrum lumen of the stomach within the anatomy reduces the chance of aspiration. at least thats what ive been told by instructors when i was in emt class. could be wrong but it made sense when it was explained to me


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## itserik1234 (Mar 24, 2012)

Bruiser said:


> LLR due to the position of the gastric and antrum lumen of the stomach within the anatomy reduces the chance of aspiration. at least thats what ive been told by instructors when i was in emt class. could be wrong but it made sense when it was explained to me



I was told something very similar to this. It makes it less likely of aspiration...for some reason...not sure why though lol :wacko:


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## jwk (Mar 24, 2012)

itserik1234 said:


> I was told something very similar to this. It makes it less likely of aspiration...for some reason...not sure why though lol :wacko:



Honestly, it makes absolutely no difference.


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## AnthonyM83 (Mar 24, 2012)

I don't know enough to say it makes no difference, but not a large one anyway and everyone seems to have different reasons. Main ones I've heard are 1) to face the ambulance bench seat  2) to make vomiting and thus aspiration less likely  3) allows heart to have better output (not sure how unless pregnant)

Additionally some say to just use left for all cases to cover all the reasons above plus pregnancy issues, so you don't have to be thinking left or right for each patient. In the end, either side is almost always fine, even in late pregnancy.


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## Fox800 (Apr 7, 2012)

Disregard.


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## jxjcc (Apr 8, 2012)

itserik1234 said:


> I was told something very similar to this. It makes it less likely of aspiration...for some reason...not sure why though lol :wacko:


Has to do with the orientation of the stomach. LLR allows gravity to "push" stomach contents away from the esophageal sphincter, making it a bit less likely those contents will be allowed into the esophagus and thus decreasing the chance for aspiration.

As has been mentioned though, pt position in the rig is just as, if not more, compelling for LLR than the possibly decreased likelihood of vomit.


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