Airway Management in Seizures

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TreySpooner65

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I am currently not working in ems but looking for work. Since I am not practicing I try to quiz myself on things regularly. One thing I cant remember from my EMT class is how to maintain an airway during a seizure.

My local protocols say "Maintain airway as indicated"

So my question is, what is the proper way?

Head tilt? Do you have to worry about the tongue?
 

ArcticKat

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There is no airway to maintain during a seizure. The patient isn't breathing. That's why seizures lasting more than a few minutes are so critical.
 

Cup of Joe

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An OPA might give them something to bite down on instead of their tongue (if you can get one in while their siezing), but you're not gonna be able to bag them, and when they regain their gag reflex, you'll have to pull it out.

Also, I was taught that you NEVER put anything in the mouth of a person while their seizing, anyone else hear that too?
 

DesertMedic66

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There is nothing you can really do for airway during a seizure. You just have to wait until it's over and then reassess to decide what would be the best thing (ie NC, NRB, BVM, NPA, OPA)
 
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TreySpooner65

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I know you're not supposed to put anything in their mouth... So I guess the reason I can't remember how to maintain the airway is because you can't.
 

ArcticKat

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An OPA might give them something to bite down on instead of their tongue (if you can get one in while their siezing),

Once the teeth are clenched there is nothing to be concerned about. Either the tongue escaped injury or the injury has already occured. The only way to prevent any injury to the tongue is to place something between the teeth before the seizure happens.

Having said that I have never once seen a patient with a tongue injury as a result of a seizure.
 
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usafmedic45

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There is no airway to maintain during a seizure. The patient isn't breathing. That's why seizures lasting more than a few minutes are so critical.

They aren't fully apneic most of the time. Actually the derangement of less oxygen in, less CO2 out and an increase in metabolic demand is what makes them so dangerous. The three big reasons for negative outcome in seizures are hypoxia, hypoglycemia and hyperthermia.

An OPA might give them something to bite down on instead of their tongue (if you can get one in while their siezing), but you're not gonna be able to bag them, and when they regain their gag reflex, you'll have to pull it out.

Wanna bet? Which blithering moron told you that one?

Having said that I have never once seen a patient with a tongue injury as a result of a seizure.

I've seen minor injuries to the tongue from it. Getting punched in the mouth carries a greater risk of injury to the tongue though to be quite honest.

So I guess the reason I can't remember how to maintain the airway is because you can't.

Yeah, you can. There are two other ways into the trachea that are not the mouth. Normal procedure for me is to drop an NPA and bag if necessary. If things get really FUBAR, you can paralyze them and tube them (remember though, the seizure is still ongoing even if you give paralytics; even if the patient isn't convulsing, you can still get a lot of bad effects from protracted seizures) or you can do a surgical airway if all other options fail in a status epilepticus case.
 

MasterIntubator

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NPA is our tool of choice. Its easy, quick and when properly set it will do its job when they come out of the seizure. ( reduce the snoring, etc. ). Every couple of months we get a "seizure" that miraculously stops seizing and avoid the NPA at all costs.
:rofl:
 

sir.shocksalot

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An OPA might give them something to bite down on instead of their tongue (if you can get one in while their seizing)
Yeah, that sounds like a bad idea to me. I would second the NPA and BVM, I usually don't worry too much about the airway unless the seizure has been going on for a while and I have tried everything to stop it. That's when it's time to check a sugar, put in a line, and hall balls to the hospital.
 

EMT-IT753

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The other airway concern I have that was not mentioned is suctioning. Most seizures I have encountered have a fair amount of drooling which I would prefer to not have them aspirate. You can still get a Yankauer tip on the side of the teeth if absolutely necessary.
 

medicsb

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Use an NPA, place a NRB. You could try to bag them, I suppose, but you also risk gastric insufflation.

IIRC, the conventional definition of status epilepticus was a seizure lasting >30 minutes. So... they can flop for quite a while. If they weren't breathing at all, they'd code pretty quickly.
 

Strap

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Use an NPA, place a NRB. You could try to bag them, I suppose, but you also risk gastric insufflation.

IIRC, the conventional definition of status epilepticus was a seizure lasting >30 minutes. So... they can flop for quite a while. If they weren't breathing at all, they'd code pretty quickly.

We were taught status epilepticus > 5 minutes, or two consecutive seizures without a period of responsiveness between them.
 

medicsb

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We were taught status epilepticus > 5 minutes, or two consecutive seizures without a period of responsiveness between them.

I should have been more clear - the OLD definition was 30 minutes. (Actually, at one point is 60 minutes.) But, yes, what you were taught is the modern definition, which is much more applicable as seizures usually do not self terminate if they haven't by 5 minutes.
 

ArcticKat

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If things get really FUBAR, you can paralyze them and tube them (remember though, the seizure is still ongoing even if you give paralytics; even if the patient isn't convulsing, you can still get a lot of bad effects from protracted seizures) or you can do a surgical airway if all other options fail in a status epilepticus case.

I didn't bother commenting to that stuff because this is a BLS forum and I thought it best to leave things at the BLS level.
 

Cup of Joe

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Wanna bet? Which blithering moron told you that one?

I was taught to move objects that could be hazardous, like furniture, and just let them seize because there's nothing we can do for them. If it goes on for an extended period of time, call ALS.

I also remember some first aid class I took long before EMT class saying to roll them into a lateral recumbent position and place something soft under their head so they don't aspirate.
 

usafmedic45

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I was taught to move objects that could be hazardous, like furniture, and just let them seize because there's nothing we can do for them. If it goes on for an extended period of time, call ALS.

I also remember some first aid class I took long before EMT class saying to roll them into a lateral recumbent position and place something soft under their head so they don't aspirate.
Right but who told you that you couldn't bag them? Welcome to one bit of information almost as dangerous as the old "shove a spoon in their mouth" trick....
 

Cup of Joe

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Right but who told you that you couldn't bag them? Welcome to one bit of information almost as dangerous as the old "shove a spoon in their mouth" trick....

EMT instructor as part of the "leave em alone, theres nothing you can do till they stop." lecture we received.
 
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usafmedic45

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EMT instructor as part of the "leave em alone, theres nothing you can do till they stop." lecture we received.

Assuming that you heard him correctly, to put it mildly your instructor is a :censored::censored::censored::censored:ing moron. Just because they are seizing does not mean you are precluded or excused from providing basic life support skills.
 

Cup of Joe

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Assuming that you heard him correctly, to put it mildly your instructor is a :censored::censored::censored::censored:ing moron. Just because they are seizing does not mean you are precluded or excused from providing basic life support skills.

Would you bag them in a lateral recumbent position or supine?
 

usafmedic45

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Usually supine. If you're on scene, one would most likely have access to some form of suction. Also, despite my loathing of anecdotal evidence, I can't recall having ever seen a seizure patient (other than toxic or traumatic seizures) spontaneously vomit in 15 years.
 
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