Question from an inquisitive mind. (BLS Airway Question)

SC Bird

SC Bird

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I'm going over Airway Management as review right now, and I remembered a question I meant to ask in class today.

Arrive on scene and find an unconscious patient. As you approach, patient begins to have a seizure. What is the best method of maintaining or managing the airway?

-Matt
 
As a basic there isn't really much you can do except make sure there is nothing around him to hurt himself. If it isn't a full body seizure and you can safely open his airway with a jaw thrust maneuver then that would be appropriate. However, the best thing you can do for that patient, as a basic, is get advanced life support to him and get the seizure under control.

Is the patient unconscious because of a previous seizure or his seizure a result of being unconscious from whatever caused the altered level?
 
If a pt is in the middle of a full on tonic-clonic seizure my hands aren't going anywhere near their mouth. That being said, inserting an npa in said pt wouldn't be especially easy either. My understanding is that your best bet is to administer high flow O2 if possible and when the seizure activity has subsided consider an adjunct. Just remember, the postictal pt can be quite combative. If they're out-cold anyway, I'd definitely say go for the adjunct as soon as you are able to safely insert it.
 
Making sure I stay within my scope of practice, administer high flow O2 per standing orders (15 lpm nonrebreather) and rapid transport requesting ALS intercept.

Now if the seizure subsides and patient is still unconscious, go ahead with the OPA?

Am I along the right lines here...

-Matt
 
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thats about the size of it, keeping in mind the gag reflex.

add another vote to the staying away from the mouth in the t/c seizure.
 
I have never seen anyone bit during a seizure. Most seizures causes clinching of the jaw and the "bites" is caused by the tongue being caught in the middle. In fact, the problem is most of the seizure activity causes airway problems because of "clinched" jaws not biting. Patients seizing will "clinch" down; and do not continue to bite.

The best airway choice is positioning and the use of a nasopharyngeal airway which is easily inserted and tolerated well in seizure patients as well allows the drainage of secretions and allows suctioning too. Then place in a coma positioning (recumbent) during the post-ictal phase. (Hint.. this is usually a NREMT test question)

R/r 911
 
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Ridryder911 said:
I have never seen anyone bit during a seizure. Most seizures causes clinching of the jaw and the "bites" is caused by the tongue being caught in the middle. In fact, the problem is most of the seizure activity causes airway problems because of "clinched" jaws not biting. Patients seizing will "clinch" down; and do not continue to bite.

The best airway choice is positioning and the use of a nasopharyngeal airway which is easily inserted and tolerated well in seizure patients as well allows the drainage of secretions and allows suctioning too. Then place in a coma positioning (recumbent) during the post-ictal phase. (Hint.. this is usually a NREMT test question)

R/r 911
Click to expand...

Well put rid.
 
I haven't seen someone bit, but I've seen people smacked by flailling extremities. I'm not going anywhere near them until seizure activity subsides.
 
It is impressive how well a NPA works on a pt that is clenched. We had a FF, (Had massive CVA in his 20's) his larynx was paralyzed. Numerous Pneumonia's,
Every call he was clenched. We had just started to carry NPA's and just bringing it out, this PT. although clenched would shake his head and fight the airway. but once in place and O2 flowing, the clenching would ease.

We would call him our Energizer Rabbit.
He is at peace now. Thank the Lord.
 
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