Airway Management in Seizures

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Melclin

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We have closed circuits with soft bags which allow the pt to breath spontaneously and for you to monitor the Vt, resp rate. This has been, and is, my preference +/- a nasal airway.


I suppose a BVM would do if I didn't have anything else, but its never crossed my mind.

A first aid course? You don't think that maybe there might be some differenced between first aid for the lay person and professional management of a seizure? These people who say there is nothing to do for seizure pts, are they not even advocating supplemental oxygen?

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.

I went to a bloke two months ago, seizure disorder since having a stroke several years ago, he'd vomited a lot when we arrived and was continuously seizing. He continued to vomit periodically throughout the seizure. It was a nightmare airway to manage. So this is rare? That's good to hear.
 

Cup of Joe

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A first aid course? You don't think that maybe there might be some differenced between first aid for the lay person and professional management of a seizure? These people who say there is nothing to do for seizure pts, are they not even advocating supplemental oxygen?

First aid course was when I was like 12. And I never said not to do anything for them, just was told we should not do anything for them while they are seizing, but have now learned otherwise.

Knowing how stupid some people can be, what would you say EVERY EMT should do for EVERY seizure case? Someone thought it would be to move objects they could hurt themselves with and wait for them to stop seizing before continuing with patient care.
 

the_negro_puppy

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As others have said NPA usually due to trismus. Hopefully if you are ALS you can get midazolam (or equiv) on board quickly. If you dont need to bag, lateral position with NRB is the next go to for us.
 

usafmedic45

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I went to a bloke two months ago, seizure disorder since having a stroke several years ago, he'd vomited a lot when we arrived and was continuously seizing. He continued to vomit periodically throughout the seizure. It was a nightmare airway to manage. So this is rare? That's good to hear.

I can't recall the last epileptic I saw vomit. It's not uncommon at all with seizures due to toxidromes or increased intracranial pressure.
 

Handsome Robb

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Knowing how stupid some people can be, what would you say EVERY EMT should do for EVERY seizure case? Someone thought it would be to move objects they could hurt themselves with and wait for them to stop seizing before continuing with patient care.

Cookbook medicine much? Treat the pt with what is necessary for that pt.

Protect the pt from harming themselves and supply o2 and airway support as needed.
 

Melclin

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First aid course was when I was like 12. And I never said not to do anything for them, just was told we should not do anything for them while they are seizing, but have now learned otherwise.

Knowing how stupid some people can be, what would you say EVERY EMT should do for EVERY seizure case? Someone thought it would be to move objects they could hurt themselves with and wait for them to stop seizing before continuing with patient care.

Ah okay. Fair enough then. Perhaps I should have paid more attention to the post.

I teach my volly FRs:
- Call an ambulance (In an EMTs case, ALS).
- Apply oxygen therapy.
- Note the time at the start of the seizure/approximate the time.
- Support: Lateral position if possible (but don't force the issue), cushion for the head, move nearby objects. (I think this is mostly window dressing, I've not come across a seizure pt who was flailing so wildly that I needed a 4 metre safey cordon, but I could be wrong).
- Collect medical/recent history from family/friends.

I think the first two are the most important with a decent shot at the third. Whether or not this is appropriate for an EMT, is up to you and of course, I may be mistaken. I like the sound of my own voice enough to know that I'm wrong occasionally.
 

Melclin

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I can't recall the last epileptic I saw vomit. It's not uncommon at all with seizures due to toxidromes or increased intracranial pressure.

Ah well this could easily have been another bleed with ^ICP.
 

mgr22

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Not sure if this was already covered, but sometimes simply positioning the seizing pt on his/her side will help maintain the airway.
 

AlphaButch

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Do what you can do when you can do it. Have everything ready for when you get the chance (NPA, O2, BVM, Suction, etc). Depending on the type and severity of the seizure, you may or may not be able to treat your patient while she/he is actively seizing.

Clearing the immediate area is a good thing (depending on the seizure, throw pillows down), for both the patient's safety and to allow the provider access. Alot of the seizure calls I've done, I arrived to find the pt stuffed someplace where I end up playing contortionist or the pt has secondary injuries (normally from the initial fall upon seizing).
 

mycrofft

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Most of the bases are covered.

As with any pt contact, the biggies are what NOT to do, and the list for laypersons/bystanders is longer than those we have, right? (That presumes we all know the "wrongs" already).

EMT-B support: oxygen, call for higher EMS (might need Rx if seizures return or won't stop) , prevent harm including from bystanders, do what is needed and what can be accomplished for airway (including positioning, NPA, suction as needed). During the seizure, not too much you can do, but do what you can. Gather data as to the cause (extant disorder, poison, electricity, post-vasovagal, etc). NO ad hoc cricothyrotomies. NO thrusting of foreign objects to try to open the jaws. If you ahve an old "bite stick", toss it right now.


In the jail, first step was to spend one half second with an ammonia capsule as contact was made, but I never approached without oxygen and suction being on the way too. Easier to call it off than start it up tardily.

I have seen vomit from the onset but not during the seizure, no significant tongue lacs, some lip and gum bleeding from trauma, some pretty impressive but not serious buccal excoriations; drool was an issue more often than other fluids. Retronasal bleed from falling or being punched was sometimes apparent, but actually spotted only after the trismus had relaxed. Since we were mostly addressing saliva or fresh/little blood, just sliding the suction tip along the buccal margin was pretty good until that one guy shattered the Yankauer by biting it and the bits disappeared into his maw.
 

MonkeySquasher

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I can't recall the last epileptic I saw vomit. It's not uncommon at all with seizures due to toxidromes or increased intracranial pressure.

Same. Only seizure I had vomit during was due to ICP. Got them to the ER, seized again, coded. Older person + anticoags + head trauma.

I was taught to move objects that could be hazardous, like furniture...

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.

I tend to have my partner move furniture, I sit and craddle their head in my lap. This allows me to both prevent the head from impacting hard surfaces, and maintain an open airway as much as possible. It also allows me to do the third thing....

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:

^ THIS. If they're seizing by the time I get there (initial action, 911 call, dispatch, response time), it's either a very prolonged seizure, or another seizure without a period of responsiveness. Either way, they're serious, and I need to treat a bit more aggressive. I hold the head, ensure an open airway, and put in an NPA. They either take it like a champ or, more often than not, suddenly wake up from the seizure. And strangely enough, those are usually the people in police custody....
 

usafmedic45

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If you ahve an old "bite stick", toss it right now.

Hey....they make good finger splints. LOL
 

usafmedic45

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NPA schem-pa.


Roc/Etomidate and an ETT! :ph34r:

Yeah, except it's not going to fix the problem and it's going to piss off the ER doc.

BTW, I realize you're being sarcastic
 

Linuss

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Meh, if crap tons of ativan and versed aren't terminating the seizures, they're in status, flight (who has barbs) is really far away, and it will take me a real long time to get to the hospital, and they're desatting despite bagging... that's really all that's left. :unsure:



Having said that, my only "status" patient wasn't TOO status as to even contemplate that route :D
 
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Bullets

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One more reason i love the NPAs and pretty much allow the OPAs to gather dust. They are great at securing an airway quickly, and shoving a tube up someones nose is a quick way of sorting out real seizures from the fakers in a far more hilarious way then the arm drop.

Also, jaw screw? i actually know a squad that used to carry that as recently as 2 months ago. I threw it out
 

neslar

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you don't touch the PT while he is seizing just move furniture away and hard objects.
after PT is done seizing if he can maintain his own airway non rebreather mask will be fine.
if Pt is unresponsive head tilt chin lift will be fine, unless you suspect PT injured his spine or neck whilst seizing then insert an NPAincase he starts seizing again, you wouldn't want an OPA in his mouth and bag im with supplmental O2.
 

Medicman59

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Wow! some of you people scare me! your going to attempt to put an OPA in a Pt. having a seizure! GO BACK TO SCHOOL!
 
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