Sepsis Induced Seizure or Rigors?

[NPO]

A "squirt" of something and a nebulizer are not in the same galaxy. A dubious claim at best.

I'm aware. But nebulized epi at least is an actual treatment for airway edema, where as a "squirt" isn't.

 

[E tank]

I'm aware. But nebulized epi at least is an actual treatment for airway edema, where as a "squirt" isn't.

Right. I'm agreeing with you. Nebulized medication has both the advantages of wide dispersal of a certain amount of drug as well as the benefit of time to actually affect the tissues in the desired way. I'm not endorsing topical epinepherine for optimizing conditions for intubating airway burns without evidence, but a quick blind spray of anything immediately followed by DL is just adding complexity and wasting time.

Might be more to the story and I might not be being very fair as I don't know all of what he is proposing, but even when anesthetizing an airway with nebulized 4% lido for an awake fiber optic, a fair amount of medicine and time needs to be involved or it doesn't work.

 

[NPO]

Right. I'm agreeing with you. Nebulized medication has both the advantages of wide dispersal of a certain amount of drug as well as the benefit of time to actually affect the tissues in the desired way. I'm not endorsing topical epinepherine for optimizing conditions for intubating airway burns without evidence, but a quick blind spray of anything immediately followed by DL is just adding complexity and wasting time.

Might be more to the story and I might not be being very fair as I don't know all of what he is proposing, but even when anesthetizing an airway with nebulized 4% lido for an awake fiber optic, a fair amount of medicine and time needs to be involved or it doesn't work.

Ah okay. I understand your point now. It was a while ago and I may not be remembering properly.

 

[MSDeltaFlt]

Folks are actually wanting to sedate this poor lady? Why? She's shivering because she feels cold because she's burning up with fever because she's septic as hell. What were her mucous membranes looking like? What color was her urine? Rhonchi on her right lower lobe. Did she aspirate? The elderly do not tolerate abrupt changes very well. You start the care by trending homeostasis. You don't drop it like it's hot. The shock from the abrupt change alone can cause a lethal dysthythmia that she might not recover.

COOL her down. Don't make her shiver. She's more than likely at least 1-2 liters behind on her fluids. Give her some. And get her out of there before they kill her.

 

[Carlos Danger]

Folks are actually wanting to sedate this poor lady? Why? She's shivering because she feels cold because she's burning up with fever because she's septic as hell. What were her mucous membranes looking like? What color was her urine? Rhonchi on her right lower lobe. Did she aspirate? The elderly do not tolerate abrupt changes very well. You start the care by trending homeostasis. You don't drop it like it's hot. The shock from the abrupt change alone can cause a lethal dysthythmia that she might not recover.

COOL her down. Don't make her shiver. She's more than likely at least 1-2 liters behind on her fluids. Give her some. And get her out of there before they kill her.

Anytime there’s any question about seizure activity, the safe bet is treat it. It’s much better to give someone some benzos when they don’t really need them, then withhold them when they do. If nothing else then youve at least got a more comfortable patient.

A couple mg of versed is not going to cause a lethal dysthymia.

 

[NPO]

Some places have in protocol to administer benzos for shivering in hyperthermic patients. I don't know if this is ever done for medium to high fevers (versus extreme temperatures like heat stroke), but it's not out of the realm of possibility.