infant seizure

[Handsome Robb]

I keep hearing this, but don't quite know it yet as an EMT-B. Through research I understand its a GABA promoter and thus makes a good and almost always successful attempt at ending seizures. But how is it administered, and at what dose? I've read it could be muccul, IV, or IM. But I can't imagine putting a line in a seizing adult, let alone a seizing infant. What do y'all do?



Thanks!

It's a lot easier to start a line in a seizing patient than you'd think. When we walk into an active seizure my partner asks fire to toss a mask on then go straight for an IV while I draw up meds. If they get a line first it goes IV if I draw them first it goes IM or IN. I've got tricks for trapping arms safely or you can always ask another responder to control the arm while you start and secure the line.

Our dose of midazolam (versed) here for seizures is 2 mg q3-5 minutes with a max total of 10mg for adults and pediatrics is 0.2 mg/kg q5 minutes like I stated before. It was kinda buried in my post though so no worries.

 

[mycrofft]

I disagree with actively cooling this patient unless they're ridiculously febrile. What causes seizures related to temperature is the rapid change in body temp or "spiking a fever". It can go the same way when reducing a fever. Reduce it too fast and you could cause another seizure if they aren't still seizing. Now if they're broiling their brain then yes, we need to do something.

Yup. Fever is not the demon we once thought it was. Cooling the baby can be like spineboarding and giving O2 to everyone: don't just stand there appropriately, doing something.

 

[OnceAnEMT]

It's a lot easier to start a line in a seizing patient than you'd think. When we walk into an active seizure my partner asks fire to toss a mask on then go straight for an IV while I draw up meds. If they get a line first it goes IV if I draw them first it goes IM or IN. I've got tricks for trapping arms safely or you can always ask another responder to control the arm while you start and secure the line.

Our dose of midazolam (versed) here for seizures is 2 mg q3-5 minutes with a max total of 10mg for adults and pediatrics is 0.2 mg/kg q5 minutes like I stated before. It was kinda buried in my post though so no worries.

Roger that. How does IN (I'm assuming that's intranasular) work with a seizing patient?

 

[chaz90]

Roger that. How does IN (I'm assuming that's intranasular) work with a seizing patient?

IN=Intranasal

In my experience, not overly well. Like I said, I prefer IM every time given a choice.

 

[Handsome Robb]

Roger that. How does IN (I'm assuming that's intranasular) work with a seizing patient?

Intranasal.

It works well for pedis, not worth :censored::censored::censored::censored: in adults but that's anecdotal.

I had a kid with complex bilateral congenital hip defects that made him prone to dislocations on top of his severe reduction in mental capacity, gave him 25 of fent IN and he went fry screaming to cooing and blowing spot bubbles in about 5 minutes. Didn't even whine when we moved him.

I've given adults 8-10 times that IN through multiple doses and had zero effect.

I've only given midaz to a pediatric once IN but it did what I wanted it to without repeating the dose. Again, anecdotal.

Just make sure they don't have a runny or bloody nose cause then it won't work.

 

[OnceAnEMT]

Thanks for the info guys. Yeah, I just imagined the versed becoming the bubble when administered IN But if it works it works.

 

[NomadicMedic]

The whole IN debate is purely anecdotal. It may depend on the med concentration, the condition of the patients nares and provider training and expectations.

I've had 5mg/1ml of midaz work like a champ. 5mg/5ml, not so much.

50mcg of Fent for a tib/fib worked great once, didn't the next time.

Narcan IN works 100% of the time for me.

Would I start with IN versed on this kid? Probably, while I looked for IV access or drilled an IO.

 

[zzyzx]

No luck with stopping the seizure with benzos. You don't have Propofol or RSI drugs. No anti epileptics. You cannot get an accurate Spo2. Nothing else on the Hx and parents speak little English. Baby is continuing to have t-c seizure. Looks pale. Your company does not provide rectal thermometers

Again I'm just wanting to see how you guys would handle this call

 

[FLdoc2011]

Get thee to a hospital.

So no luck stopping seizures after how much benzos? Keep them coming and intubate.

 

[chaz90]

Yeah, intercept with someone who has RSI capability if they're anywhere in between you and the hospital (still 1 hour away?) and keep throwing benzos at them. Tough call scenario, but at this point EMS treatment options are really quite limited...Keep on driving.

 

[NomadicMedic]

I think you've reached the endpoint, since you've exhausted all of the options.

 

[zzyzx]

Yeah I guess I agree. I have never had a call like this but am wondering if anyone has, or one where they had to bag an infant or young ped during a long transport time

 

[Rialaigh]

No luck with stopping the seizure with benzos. You don't have Propofol or RSI drugs. No anti epileptics. You cannot get an accurate Spo2. Nothing else on the Hx and parents speak little English. Baby is continuing to have t-c seizure. Looks pale. Your company does not provide rectal thermometers

Again I'm just wanting to see how you guys would handle this call

No screwing around after the second round of benzo's, if flights not available and we are an hour from a hospital the kid is getting RSI'd now.

 

[NomadicMedic]

No screwing around after the second round of benzo's, if flights not available and we are an hour from a hospital the kid is getting RSI'd now.

I'm assuming you didn't read the whole thread, so you missed the part where he said "no RSI". (Although I'm not sure how you did that, as you quoted his post where he mentioned no RSI)

This is really not a great scenario, The OP just wanted an opinion on "what we would do". We all pretty much said the same thing; benzo's, airway support and transport. I don't know what else he's looking for, since he shut down all other avenues for a more rapid transport via helicopter and advanced airway management with RSI. At this point, all you've got left is "drive fast"

 

[Carlos Danger]

Yeah I guess I agree. I have never had a call like this but am wondering if anyone has, or one where they had to bag an infant or young ped during a long transport time

Are you REALLY over an hour from the closest hospital, and do you really not have ALS or HEMS available, or was this purely hypothetical?

If this scenario ever happens, it may not end well for the kid. Continuous generalized seizures for well over an hour can potentially fry a brain pretty good. Especially considering the challenges of providing effective BLS ventilation in a moving vehicle for that length of time.

I do think it's a good thought exercise to consider these worst-case scenarios. Much of the value in it is understanding that we are limited in what we can do, and sometimes our best efforts will not be enough. You can't save 'em all.

A few folks mentioned RSI and while securing the airway and providing ventilation and oxygenation is certainly a high priority in status epilepticus, it doesn't necessary solve the problem - you very well may still have an imbalance between cerebral oxygen demand and delivery once they stop moving from the NMB's. They need DEEP sedation (+/- NMB) and still need to get to an ED ASAP. I know most of those who replied here understand this, but I figured it was worth underscoring.

 

[FLdoc2011]

And really NMB is not needed here and won't help.

Anticonvulsants, benzos and maybe barbiturates to stop the seizures. In the hospital we'll just induce basically general anesthesia or something like a phenobarbital drip while monitoring an EEG.