Seizures

Anjel

Anjel

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Ha look at me....posting in the ALS section.

I am curious as to what your protocol dictates for your first line seizure drug?

We are finishing up with pharmacology and there have been at least 5 different drugs for seizures.

My protocol here gives us three choices. Vallium, Versed, or Ativan. Valium being pre-radio.

What is your preference and what dose/route do you normally go with?
 
Versed. That's all we carry haha.

And I've seen it given IN mostly.
 
We also only carry versed. Hopefully Ativan eventually but we will see.

If I see a line my partner can get quickly while I draw up the versed I'll go that route with 2 mg. Otherwise it's 0.07 mg/kg to a max of 7 mg IM.

We don't have to call for orders for benzos unless we max out our dosage.

We have the option of IN as well but it isn't used much that I have seen. Also it's bad to say it influences my decisions but my preceptor likes IM over IN for versed in seizures so that's what I reach for.
 
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The only benzodiazepine we carry is Versed...so I give that.

Our dose is 0.3 mg/kg, we only have to call for orders when we exceed 30 mg. I would like to see Ativan here, but I don't see such an event in the near future.

EDIT: we just got the MADs, so that will soon be added to our protocols as well for Versed administration.
 
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Peds:
Glucagon
Dextrose
Versed, Valium

Adult:
Versed, Valium

Pregnant:
Magnesium Sulfate drip.
 
Versed IV, IM, or IN, 5mg bolus for adults, max 10 mg. 0.15 mg/kg for peds IVB or IM, 0.2mg/kg IN, max adult dose.

Eclamptic Sz, Mag Sulfate 4G/100 ml NS @ 60 gtts/min. If Mag OD, CaCl 10% 10ml SIVP over 2 mins, w/ one repeat if necessary.

We can give Versed to the pregnant pt if the Sz is refractory to Mag; it's a judgment call for us.
 
Same as 46Young plus Valium 5mg or 0.1mg/kg to 5mg with a repeat dose to 10mg. We also have a Careflite activation for Special Circumstances. (ie traumatic seizure or third-trimester ecclampsia).
 
Rocketmedic40 said:
Same as 46Young plus Valium 5mg or 0.1mg/kg to 5mg with a repeat dose to 10mg. We also have a Careflite activation for Special Circumstances. (ie traumatic seizure or third-trimester ecclampsia).
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The department took valium away from us in 2010. Most kids with a Sz Hx will have a rectal Valium script that the parents handle, and we always have the IN route if we don't want to stick them. I do miss having the discretionary option for Valium as a muscle relaxant for a Fx, but I digress...
 
How long does it take for IM versed as opposed to IVP. It just seems hard getting a line in someone who is seizing.
 
Anjel1030 said:
How long does it take for IM versed as opposed to IVP. It just seems hard getting a line in someone who is seizing.
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IV advantages: quick onset, More reliable onset and duration (IM absorption can be uneven)

IM advantages: Possible longer duration of action, don't have to stick someone.

There might be some noticeable delay in action but nothing extraordinary (with IM).
 
Am I correct that valium cannot be given IM?

Just IV and rectal?
 
Versed and Valium. Versed is drug of choice but Valium is used for things that I can't get into here.

Versed IN is my choice; IN is about 40-50% longer to act than IV. but you usually won't notice a difference
 
johnrsemt said:
Versed and Valium. Versed is drug of choice but Valium is used for things that I can't get into here.

Versed IN is my choice; IN is about 40-50% longer to act than IV. but you usually won't notice a difference
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Ya unfortunately we cant give any drugs here IN.
 
I like versed, because I have used it a lot and I am comfortable using it.

No other particular reason.
 
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