Do you give benzo's to a hypoglycemic seizure?

[Ace844]

Hi All,

To further illustrate another side to this, I'd like to take a second to present another possibility to the group. I'll keep this very general and take some expansion liberties to make a point for the large picture purpose of this post. So here it goes.

Ok, so since we are talking about Sz D/O's in Diabetic's; lets say that you arrive on a scene to find a patient whom has a PMH of IDDM, and is actively seizing. Also lets say that since as "Asysin2leads" has pointed out in the last post that we are all of 2 camps. Camp A in this case stabilizes the patient via giving Lorazapam, (or which ever anti-seizure med your protocols allow you to use), and that the seizure breaks, lets all so say that after or before the med was given that IV access was sucessfully obtained, and then the patient got a full assessment including a FSBS/BGL, then Group A treats whatever underlying disorders they may find.......

Now conversely, we go to the second "group", Group B.

Group B (Which may or may not be as protrayed by "Asysin2leads", whom assumes that you haven't had the opportunity to actually treat a seizure before reading about it in a book some place) Arrives to find the same patient and immediately upon learning the patient is a diabetic, assumes that because the patient is a Diabetic, or upon a FSBS/BGL reading that is low, assumes this is a primary Diabetes related disorder only. So thus this "group", either with or without Iv access gives either Glucagon, or D50, (Or what ever sugar "boosting" solution you prefer, or protocol allows. This may or may not stop the seizure in which case "Group B" would then hypothetically and Hopefully search for other causes and also give Benzo's to break the seizure.

The problem with these above approaches which the "groups" fail to take into account is as follows.....

A.) As referenced by "Asysin2leads" in their post, that "Group B" has unequal experience from "Group A" and that this may be abit too much of a generality.

B.) Having said that "Group A" I believe is taking the better approach because they are treating their "patient" with the awareness that there are other things that cause a Seizure than just hypoglycemia in a diabetic patient. They treat the seizure and once the Airway and life threatening Seizure is "stopped", they then proceed to assess and treat all further life threats, and electrolyte disorders

C.)As "buddha", and to add to his statement of,

"Active seizures lead to hypoxia, obstructed airway, and if untreated, death."

The fact that a patient who is or has seized, will most likely be hypoglycemic as all of that motor activity "burns" alot of the glucose reserves in the body!!! :idea: :!:

D.) The fact that one of our "groups" fails to understand that indescrimenately giving "Glucose" to a patient can very be harmful, regardless of PMH. A quick example of this off the top of my head.....Let's say that in the above and the scenario which caused all of these posts the following happened.

1.) Group A did as posted above, and found that their patient had a low BGL level but didn't aggressively correct it because they foud Objective assessment evidence of a "intercrainal bleed"....Now had they given this patient "a bolus of D50/Glucagon/etc...." then they would have significantly worsened this patients out come and caused harm by increasing the "bleed" situation.

2.) Group B provides a different Rx, approach and give "sugar" then when the seizure doesn't stop, gives some Benzo's to stop the patients seizing, and also begins to think of other causes.....Which incidentally provides them with the problem of having administered a med to a patient which caused their condition to worsen, and is not something they can "take back." Had Group B appraoched the patient as they have been trained since the enception of their EMS career, and treated the immediate life threats first, (In this case the lack of a patent airway, and the seizure activity) as well as doing a comprehensive thorough assessment, they would have found that this patient had a different reason to "seize" other than just assuming it was their "Diabetes" that caused it. Also they would have provented themselves from making the "error" of giving a med to a patient which would cause their condition to worsen (This being the "true underlying cause" which wasn't the one they assumed and immediately treated), rather they treated based on incomplete info. and disregarding other equally important possibilities.

E.) As "Buddah" noted it is very "hard" to get a IV in an "actively seizing" patient.

The Take home lessons are these::

** ASSESS, ASSESS, ASSESS, DON'T ASSUME ANYTHING!!

** TREAT ALL IMMEDIATE LIFE THREATS WHILE SEARCHING FOR UNDERLYING ETIOLOGY AT THE SAME TIME!!

** ONLY AFTER YOU HAVE RULED OUT ALL OTHER DISORDERS AND ARE LEFT WITH 1 OR 2 AS THE ONLY DDX'S LEFT THEN TREAT THESE

** KNOW THE MEDS YOU ARE ADMINISTERING AND WHAT THE PEARLS AND PITFALLS OF THEM ARE!!

** WHEN IN DOUBT ASK QUESTIONS !!

Hope this helps, Out here,

Ace844

[1EMT-P]

Asysin2leads & Ace844 are you guys new medics? Because you sure do sound like it.

There are an estimated 15 million diabetics in the United States and EMS personnel are frequently called to provide emergency medical assistance to these patients due to problems related to their diabetes. The most common emergencies include: diabetic ketoacidosis ( high blood sugar ) and hypoglycemia ( low blood sugar ). Both of these conditions if left untreated can be life threatening.

S/S of Diabetic Ketoacidosis: Warm, dry skin; nausea & vomiting, tachycardia, Kussmaul's respirations ( deep & rapid breathing ), polydipsia, polyphagia, polyuria & fruity odor on the breath.

S/S of Hypoglycemia: Cool, clammy skin, slurred speech sometimes confused with CVA, headache, weakness, agitation, aggressive or abnormal behavior, dilated pupils, seizures, decreased level of consciousness & coma.

The treatment objectives include: 1. Maintain ABC's ( 02 & NPA work wonders ). 2. Establish if the patient is hypoglycemic. 3. Normalize the patient's blood glucose level & 4. Provide supportive care.

Status epilepticus is defined as a continuous seizures lasting 30 minutes or more and this is considered a true medical emergency.

Please note that Diazepam ( Valium ) & Lorazepam ( Ativan ) are considered the drugs of choice when treating a seizure in the field. Midazolam ( Versed ) is a benzodiazepine; tranquilizer & amnesic medication used to reduce anxiety, provide short term CNS depressant action & induce amnesia.

Indications Include: 1. Premedication for intubation or synchronized cardioversion. 2. Chemical Restraint.

Contraindications Include: Shock, severe hypotension, narcotic overdose, use of other CNS depressants or hypersensitivity.

Side Effects Include: 1. Respiratory depression , 2. Headache, 3. Amnesia, 4. Hypotension, 5. Cough & 6. Nausea & Vomiting.

Before you reach for that Versed or any other drug for that matter know what the drug does, know how the drug works, know the right dose and the drugs indications and contraindications :!:

[Asysin2leads]

New medics? Oooooh...

Again, I have someone who quotes from statistics and studies and glosses over the fairly obvious, that you can't get an IV on an actively seizing paient. It's nice that you just kind of assume that I have no idea about diabetes, or the pharmacodynamics of benzodiazapines. Arrogance and medicine never produced really good results.

[buddha]

The most common emergencies include: diabetic ketoacidosis ( high blood sugar ) and hypoglycemia ( low blood sugar ). Both of these conditions if left untreated can be life threatening.

So you want to play, 1-EMTP?? In 22 years, I have never seen DKA to be acutely life threatening. DKA takes days or weeks to manifest, and progresses slowly - unlike hypoglycemia, which is very acute and often ocurs without warning. These two processes are very different. How do you propose to fix DKA in the field, if it is an immediate life threat? I didn't think so.

It is true that hypoglycemia can be fatal if untreated, but so can airway obstruction, cva, or toxicity. Sugar should not be given blindly on the "hunch" that a seizure is hypoglycemia related. A couple minutes without oxygen will do as much or more damage than a couple more minutes without sugar. You still gotta break the seizure first and then treat what you find.

[THE_DITCH_DOCTOR]

New medics? Oooooh...

Again, I have someone who quotes from statistics and studies and glosses over the fairly obvious, that you can't get an IV on an actively seizing paient. It's nice that you just kind of assume that I have no idea about diabetes, or the pharmacodynamics of benzodiazapines. Arrogance and medicine never produced really good results.

He tried to pull that with me when I first started on this site, Asys. New....yeah, sure.....granted I don't have Rid's or Buddha's level of experience but I'm pretty far removed from being a wide-eyed newbie.

I get the feeling that 1EMT-P and Ace844 are the Kings of Cut and Paste posting. :roll: Reading their posts reminds me of reading the little bullets of information you find smattered around various websites about health care......Hmmmmmm...... :?

[Ace844]

He tried to pull that with me when I first started on this site, Asys. New....yeah, sure.....granted I don't have Rid's or Buddha's level of experience but I'm pretty far removed from being a wide-eyed newbie.

I get the feeling that 1EMT-P and Ace844 are the Kings of Cut and Paste posting. :roll: Reading their posts reminds me of reading the little bullets of information you find smattered around various websites about health care......Hmmmmmm...... :?

Dear USAF,

Hmm, can't decide if your being facetious, or trying to goad me into a largly hostile response.....As far as cutting and pasting, yeah I do it, mostly to make a point...seems you do it alot as well...yet, I haven't accused you of being in the same league with another poster on these forums with whom you've had disagreements with. Also, In my posts, I agreed with "asys", and moved on to further posts examples of what "some" of us we're already saying. Also, with what you posted, you "agreed" with my responses...so does that mean you are calling yourself wrong as well???? :?: :!: :arrow: At this point "Steve", you seem to very much be the proverbial "pot calling the kettle....." So what's/why the issue?

As far as being new..yeah I'm a rookie, with 10 or so years of urban 911 (with some tranfer stuff mixed in)...worth of experience...newer than some, more experienced than others....it seems?!! :wink: :twisted: It seems I that I learn new things in medicine all of the time, sometimes here, or even other places..but at no point do I porport to be the end all be all...do you>!?!?!?!!?!? :roll: :idea: Still i have yet to marginalize you or your posting efforts....so thus I look forward to your response or flames...whichever may come!!

Out here,

Ace844

[Ace844]

You obviously need glasses or to reread my posts as I wrote in my post the following;

Camp A in this case stabilizes the patient via giving Lorazapam, (or which ever anti-seizure med your protocols allow you to use),

. So to further alleviate the need to "reeducate you" or as you so gallantly wrote,

1EMTP-Before you reach for that Versed or any other drug for that matter know what the drug does, know how the drug works, know the right dose and the drugs indications and contraindications

Perhaps you should read what "USAF" posted and make sure you are addressing the correct person before attcking another.

THE_DITCH_DOCTOR Posted: Wed Jul 27, 2005 11:55 pm Post subject:

--------------------------------------------------------------------------------

Versed = midazolam

Ativan = lorazepam

Both benzodiazepine anticonvulsants and sedatives

Also, since you asked here's a place and some links where you can educate your self on

Versed or any other drug for that matter know what the drug does, know how the drug works, know the right dose and the drugs indications and contraindications

....http://www.mentalhealth.com/drug/p30-a04.html

where it states clearly

" While lorazepam has been shown to control status epilepticus promptly, it is not recommended for maintenance treatment of epilepsy. After seizures are controlled, agents useful in the prevention of further seizures should be administered. In the treatment of status epilepticus due to acute reversible metabolic derangement (e.g., hypoglycemia, hypocalcemia, hyponatremia) immediate efforts should be made to correct the specific defect.

But I'll leave you to go and take the time to read the rest yourself.

the next link will educate you on Versed it's; http://web1.caryacademy.org/chemistry/rush...harmacology.htm

As for Versed's uses in seizure treatment well you can read a quick article here: http://my.webmd.com/content/article/108/109032.htm

Now of further note to your attacks/objections to these posts I noticed that you had nothing to say in the thread "Nasal atomizers as posted by various other posters in this forum ( here's the liink in case your "unable to find it, www.emtcity.com/phpBB2/viewtopic.php?t=373&postdays=0&postorder=asc&start=0 Now I'm curious as to whay you posted no issue there over the use of nasal atomized "Versed" in seizures...hmmm food for thought or is hypocracy your only weapon as wit surely isn't in your reportoire!! :idea: :!: :roll: :twisted: :shock:

Out here,

Ace844

[THE_DITCH_DOCTOR]

[kevkei]

(Sorry to beat a dead horse) I'm new and this is my first post, so I'll keep it short. Information in the original post:

You have a pt in say status epilepticus

Based on the descriptor here and to be literal, a hypoglycemic seizure really isn't status epilepticus. This patient, although has a BGL of "<4 mmol/L" (72 g/dL) , I would not expect to seize unless they were significantly hypoglycemic, a BGL of <2 mmol/L (36g/dL). If they are mildly hypoglycemic, that isn't the problem so then treat with a benzo.

If they are moderate-severely hypoglycemic and if I have no history or indication that the patient is IDDM, I'll try to treat both problems concurrently. I'll administer both a benzo and the glucagon IM.

As for being unable to start an IV on a patient in a status, generalized seizure: Since when? I have treated many-a-status seizure and have never had to administer anything IM or rectally in a non-peds patient. Why, because I have always been able to get a line, typically on the first attempt.

[Guest]

Ya right , I have seen your I.V.'s , you can always get ex-j, best let the EMT do it. Just kidding Kev.