# Seizure-Medication Bill Brings Relief in Calif.



## Fish (Nov 2, 2011)

Thoughts?

http://www.jems.com/article/news/seizure-medication-bill-brings-relief-ca


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## abckidsmom (Nov 2, 2011)

Are we thinking about the nursing politics or whether we think that laypeople should be administering Diastat?


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## 18G (Nov 2, 2011)

I agree with the law allowing a lay-person to administer a benzo to a seizing child. Definitely. I do think a better option exists other than Diastat. That stuff is mighty expensive (like $300-$400 expensive for 2/10mg syringes).

Midazolam IN is less than $20 for med and delivery device, and is less socially awkward to administer.


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## jjesusfreak01 (Nov 2, 2011)

Nursing boards are retarded. They argue in this article that:

1. Schools will feel they don't need to hire nurses anymore because laypeople can give Diastat

This should annoy nurses too, because it downplays the larger part of their role as contacts for preventative care and community medicine.

2. That administering a medication constitutes "nursing", and training someone to give a rectal medication is teaching nursing to non-licensed individuals. 

By this logic, i'm a nurse...you can call me Nurse Brad (Note that by law I cannot actually call myself Nurse Brad). Also, apparently I can teach nursing. Putting that on my resume. 

"Nursing unions and their allies have vociferously disputed the risks of administering Diastat, saying that it could be given mistakenly to a convulsing student who does not need it or by a layperson who panics under pressure and delivers the wrong medication or dosage." 

If the kid is being prescribed an emergency seizure medication, then any incident, in which he is convulsing and is unable to express to his teacher that he would prefer he not be given rectal medication, is a seizure.


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## JPINFV (Nov 2, 2011)

jjesusfreak01 said:


> By this logic, i'm a nurse...you can call me Nurse Brad (Note that by law I cannot actually call myself Nurse Brad). Also, apparently I can teach nursing. Putting that on my resume.



By that logic, we could also call it a practice of medicine too. Notice the article isn't saying that physicians are crying over this. 

On a side note, while looking through California's medical practice act, apparently if I'm licensed in California once I finish school I can use the post nominal MD, even if I hold a DO.


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## usalsfyre (Nov 2, 2011)

One more example of the nursing ivory tower trying to protect their perceived "turf". 

Yet they actively campaign to encroach on others...


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## Fish (Nov 2, 2011)

I think it is a great idea, however. Imagine the 13-14 y/o girl who starts the seize in the middle of class and someone has to remoe her pants and underwear to administer this rectal Valium. I hope that Teachers ask students to leave the room so that kids private areas are not being exposed to other students.


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## Sasha (Nov 2, 2011)

Fish said:


> I think it is a great idea, however. Imagine the 13-14 y/o girl who starts the seize in the middle of class and someone has to remoe her pants and underwear to administer this rectal Valium. I hope that Teachers ask students to leave the room so that kids private areas are not being exposed to other students.



You're really suggesting waiting for 30 panicked and fascinated kids to file out before administering seizure meds?

Sent from LuLu using Tapatalk


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## usalsfyre (Nov 2, 2011)

Considering the increased cost of Diastat over the above mentioned midaz and the social issues with administering rectal meds...Valeant must have an incredibly attractive marketing team .


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## Fish (Nov 2, 2011)

Sasha said:


> You're really suggesting waiting for 30 panicked and fascinated kids to file out before administering seizure meds?
> 
> Sent from LuLu using Tapatalk[/
> 
> ...


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## JPINFV (Nov 2, 2011)

Fish said:


> I don't see that taking very long, while this Kid needs to have the seizure stopped their privacy also needs to be maintained. Don't tell me as a Medic you would pull down someones pants and administer rectal meds on a teenage girl in a class with everyone watching when you could of kicked them out first. That girl will thank you later for protecting her modesty
> 
> Plus, I really don't see the need for the rectal administration. I think the IN is a better option.




If the patient is still seizing by the time EMS arrives (mind you, this includes the following time intervals: recognition, calling 911, call taking, dispatch, time to ambulance, response time, time from ambulance to patient, and initial assessment), the last thing I'm concerned about at that time is the patient's dignity. However, hopefully the EMS crew has better options than PR medication.


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## JPINFV (Nov 2, 2011)

usalsfyre said:


> Considering the increased cost of Diastat over the above mentioned midaz and the social issues with administering rectal meds...Valeant must have an incredibly attractive marketing team .




...or a really good PR team. h34r:


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## Fish (Nov 2, 2011)

JPINFV said:


> If the patient is still seizing by the time EMS arrives (mind you, this includes the following time intervals: recognition, calling 911, call taking, dispatch, time to ambulance, response time, time from ambulance to patient, and initial assessment), the last thing I'm concerned about at that time is the patient's dignity. However, hopefully the EMS crew has better options than PR medication.



The EMS crew has plenty of time to clear the classroom while drawing up a Med, or putting together a Medication Device or atleast have someone hold up a sheet to block the view.


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## Handsome Robb (Nov 2, 2011)

IN is a better option than PR in my opinion. IN is proven to act faster than IM *if administered correctly* and most definitely PR administration. Would the Diastat even have taken effect by the time EMS arrives if given PR? How long is activation of EMS going to be delayed by a teacher trying to recognize the seizure, find the medication, preferably clear the classroom and then administer it?  Then you have to look at complications for the crew with already having an dose of a benzo onboard prior to their arrival. I'm green so I may just not be as comfortable with stacking medications as the more experienced crowd but I don't know how happy I'd be about giving a kid midazolam after a teacher gave diazepam prior to my arrival. If they are respiratory depressed I can bag them till the cows come home but I'd rather avoid that situation, but like I said maybe I'm still too green.

Honestly I feel like an emphasis on furthering education in recognition, activating EMS, preventing injuries secondary to the seizure activity and not jamming random objects into the person's mouth is more important. How are you going to take someone who more than likely sucks at even recognizing what's actually happening and ask them to react appropriately and administer a narcotic?

What happens when a kid passes out, has "seizure-like activity" so the teacher administers Diastat when the student wasn't actually having a seizure and their respiratory rate tanks?

Good in theory, but I think it needs a lot more education behind it.


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## usalsfyre (Nov 2, 2011)

Ehhh, Diastat's really not that dangerous. Absorption is slow and diazepam doesn't have much effect on respiratory drive anyway.

To this day I don't know why paramedic school scares the crap out of people about sedatives and opioids but gives out antidysrythmics like their free candy (not directed at you NVRob, your comment just made me reflect on this).


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## JPINFV (Nov 3, 2011)

Fish said:


> The EMS crew has plenty of time to clear the classroom while drawing up a Med, or putting together a Medication Device or atleast have someone hold up a sheet to block the view.




Assuming we have to go PR (in contrast to IN or IV, which isn't much of a dignity issue) and the room isn't cleared prior to arrival, how long are you going to wait for 30 kids to file out before stopping the physical manifestations of the seizure that's now going on 7-8 minutes? Sorry Mrs. Jones, we thought your child's dignity was more important than the growing hypoxia due to his seizure.


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## mycrofft (Nov 3, 2011)

*I'm done with these "news articles". Always deficient or inaccurate.*

  "Nursing unions and their allies have vociferously disputed the risks of administering Diastat, saying that it could be given mistakenly to a convulsing student who does not need it or by a layperson who panics under pressure and delivers the wrong medication or dosage".
The crux of the issue was that the nursing practice law does not allow nurses to train others to do this. Modification would allow it. Since the dosage is already set, the "wrong dose" citation is a red herring. This whole paragraph smells of an unattributed quote from an unnamed source.

OK which nursing unions and who are these "allies"? Dang few "allies" I know of. The source for the "California chapter of the American Nurses Association",  (CNA), which is a professional more than a labor organization, was cited as "Tricia Hunter". She is a RN, currently a lobbyist, and is a former Republican state assemblyman (three terms) and has had multiple gubernatorial appointments.
Her CV:  http://apcomp.net/legislative/hunter_bio.pdf 

And the shot (above) about nurses getting into everything was uncalled for.


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## usalsfyre (Nov 3, 2011)

mycrofft said:


> "And the shot (above) about nurses getting into everything was uncalled for.



Mycroft, it's not a shot directed at the everyday nurse. It's directed at the nursing academics who insist on encroaching into medicine with the DNP push, claim RNs should be allowed to do prehospital care with no additional education, state they can replace RRTs with some minimal OTJ training, ect. Yet if anyone comes near a traditionally "nursing" task they speak of the piles of bodies we're going to be wading through. 

No disrespect to the average nurse intended. But I'm really sick of listening to how RNs are going to be the saviors of health care.


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## 18G (Nov 3, 2011)

NVRob said:


> IN is a better option than PR in my opinion. IN is proven to act faster than IM *if administered correctly* and most definitely PR administration. Would the Diastat even have taken effect by the time EMS arrives if given PR? How long is activation of EMS going to be delayed by a teacher trying to recognize the seizure, find the medication, preferably clear the classroom and then administer it?  Then you have to look at complications for the crew with already having an dose of a benzo onboard prior to their arrival. I'm green so I may just not be as comfortable with stacking medications as the more experienced crowd but I don't know how happy I'd be about giving a kid midazolam after a teacher gave diazepam prior to my arrival. If they are respiratory depressed I can bag them till the cows come home but I'd rather avoid that situation, but like I said maybe I'm still too green.
> 
> Honestly I feel like an emphasis on furthering education in recognition, activating EMS, preventing injuries secondary to the seizure activity and not jamming random objects into the person's mouth is more important. How are you going to take someone who more than likely sucks at even recognizing what's actually happening and ask them to react appropriately and administer a narcotic?
> 
> ...



A study was done comparing the efficacy of IN midazolam to PR diazapam and the two came out pretty even in terms of onset and seizure control. Midazolam had a slightly faster onset of action but not by much if I remember.  PR meds get absorbed pretty quick but absorption can be affected by the obvious. So to answer your question, yes the Diastat should have taken effect prior to EMS arrival in most cases. 

If the child is still actively seizing after EMS arrives, I would confirm that the Diastat was properly administered (ie is more outside the rectum than inside and check the syringe). Benzodiazopines are really safe drugs and the last time I researched it no lethal overdoses have ever been reported. The lethal overdoses involving benzos occurred with other substances like alcohol and opiates. So I wouldn't be too worried about giving an additional benzo if needed. 

It would be unlikely that Diastat causes any respiratory depression at all. The greater risk of hypoxia and resp depression comes from allowing the seizure to continue. And I would rather bag a patient and control the airway on a patient who is sedated, than to try and bag one who is seizing.   

One thing to also keep in mind is schools that are for special needs students. Many of these students may have seizure disorders at a higher rate than a standard school population. So this law would be great for this setting.  

PR medication in a school setting is pretty awkward. Yeah, you could clear out a classroom, but what about in a lunch room or outside at recess? The push needs to be for IN midazolam.


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## mycrofft (Nov 3, 2011)

*Agreed about "Ivory Tower Nurses".*

Yes, some of them are nursing jingoists. And no nurse should pull the "I'm a nurse and you are an ignorant technician" stunt, *ever*.
We nurses are sort of like caulk, we tend to be put where there's a hole and nothing already designed to fill it; then we sort of root in and grow.h34r:


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## CAOX3 (Nov 3, 2011)

Ridiculous.

Epileptic s seize rarely is it emergency, need medication administration , ER evaluation or an ambulance.

Educate them in abnormal  activity that would constitute  those things, such as history, prolonged  seizure activity or injuries thst may have been sustained during the seizure.


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## 18G (Nov 3, 2011)

CAOX3 said:


> Ridiculous.
> 
> Epileptic s seize rarely is it emergency, need medication administration , ER evaluation or an ambulance.
> 
> Educate them in abnormal  activity that would constitute  those things, such as history, prolonged  seizure activity or injuries thst may have been sustained during the seizure.



I agree most of the time the seizure will have ceased prior to EMS arrival with no medication needed. But I don't think we should be assuming this mentality. The risks of hypoxia, resp arrest, and aspiration are very real. And the longer a seizure is permitted to continue, the harder it is to stop with medication. 

Who knows if a child's 11th seizure may be the one that doesn't break on it's own. What if a child has undergone a change of medication or dosage or in this economy the parents weren't able to get the med refilled for a few day's after the prescription ran out?  And now this child is not coming out of the seizure?


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## Fish (Nov 4, 2011)

JPINFV said:


> Assuming we have to go PR (in contrast to IN or IV, which isn't much of a dignity issue) and the room isn't cleared prior to arrival, how long are you going to wait for 30 kids to file out before stopping the physical manifestations of the seizure that's now going on 7-8 minutes? Sorry Mrs. Jones, we thought your child's dignity was more important than the growing hypoxia due to his seizure.



Thats where the sheet comes in, every Stretcher has extras... and takes no time for someone to unfold one


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