Seizures

[Anjel]

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?

 

[DesertMedic66]

Versed. That's all we carry haha.

And I've seen it given IN mostly.

 

[Handsome Robb]

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.

 

[fast65]

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.

 

[NYMedic828]

Peds:
Glucagon
Dextrose
Versed, Valium

Adult:
Versed, Valium

Pregnant:
Magnesium Sulfate drip.

 

[46Young]

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.

 

[RocketMedic]

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).

 

[46Young]

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).

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...

 

[Anjel]

How long does it take for IM versed as opposed to IVP. It just seems hard getting a line in someone who is seizing.

 

[rwik123]

How long does it take for IM versed as opposed to IVP. It just seems hard getting a line in someone who is seizing.

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).

 

[Anjel]

Am I correct that valium cannot be given IM?

Just IV and rectal?

 

[TheGodfather]

valium can be given IM

 

[johnrsemt]

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

 

[Anjel]

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

Ya unfortunately we cant give any drugs here IN.

 

[Veneficus]

I like versed, because I have used it a lot and I am comfortable using it.

No other particular reason.