Airway for seizure patients?

[RedheadErin]

It came up in class the other day, but I was focusing on how to operate the King tube, so I wasn't really paying attention.

Is there ever a situation in which you would put an airway, such as a King tube, in a seizure patient? I have seen a few patients who were postictal, and while they were exhausted and out of it, they were not so far down the LOC scale as to need an airway adjunct.

 

[chaz90]

As BLS, you won't ever be able to get a King Tube into someone who needs it due to a seizure. There is a place for advanced airway placement in status epilepticus, but it comes after treatment with benzos and likely RSI.

 

[VFlutter]

If they totally lose their gag and are apenic for a prolonged period of time then a King tube may be indicated. But besides that, No.

A patient having a seizure may or may not lose their gag reflex. In my experience most maintain it. If they maintain a gag reflex then they do not get any type of oral airway. And of course do not stick anything in their mouth when they are actively seizing. A NPA would be a good option. Suction is also very important in a postictal patient as many will have significant oral secretions. A seizure patient with apneic periods most likely will require high flow oxygen. One of the rare situations I would say that.

Your best bet would be recovery position, NPA, suction, 02, and save environment (Remove tight clothes, pad the side rails, etc).

 

[NomadicMedic]

In short, no.

A BIAD, like a king or combitube is ONLY for arrests in the BLS world. (They're a backup/rescue airway for ALS, but that's a different scenario.)

If your patient was totally out of it and required a BVM to assist ventilation, you'd be better off with two NPAs and maybe an OPA if they had no gag.

 

[Handsome Robb]

In short, no.

A BIAD, like a king or combitube is ONLY for arrests in the BLS world. (They're a backup/rescue airway for ALS, but that's a different scenario.)

If your patient was totally out of it and required a BVM to assist ventilation, you'd be better off with two NPAs and maybe an OPA if they had no gag.

Agreed. If its an epileptic seizure that gag will be returning shortly once you oxygenate them so be ready to pull that OPA if you elect to place one.

 

[mycrofft]

1. No respirations during a grand mal. Only need for an airway would be to try to force in air. If chest muscles and diaphragm are clenched, air will go where?.....
2. Post-ictal, #1 threat to airway is embaressment by secretions, blood, tongue and other soft tissues. Might simply Modified HAINES or "recovery" position suffice?
3. If another seizure is potential, then think about what will secure the airway and keep the patient from chomping through the airway, keep the respiratory muscles from preventing inflations, etc.....