Do you give benzo's to a hypoglycemic seizure?

[Ridryder 911]

Again, semantics..c'mon lets grow up. Treat the patient ... not the s/s . If you are able to obtain the history of hypoglycemia.. you treat the glucose, if not treat the seizures..GEEZ.. who CARES ? It takes you a whopping 15 seconds to find out the glucose level in 30 seconds to administer 12 gms in an establish IV to stop the seizures or 45 seconds to administer Valium.. ( oh by the way for you probies.. you are NEVER supposed to push Valium in a hand vein) or 3 seconds to administer Versed nasally... tomato or tomatow... lets argue about that would change the outcome. According to Emergency Medicine ..you treat the etiology first if known. if not treat the seizures ...duh! Again, you are treating both ! This is a mute point !

If your trying to impress me with you get your IV the first time, medics who say that usually means you have not started very many. I personally have established many EJ on seizing patients; BUT prefer not to... especially when armed with a 14g needle & a moving target. That is why I personally prefer nasal Versed..soes it mean you should ...no (in which new studies has shown has a higher break-through in seizure activity & faster or equal absorption rate than I.V.) .. also, my neuro's like it better because of the short half life. Again, a personal preference in my treatment modality.

Again, I too feel we are beating a dead horse (by the way a good illustration Steven) Those with experience know there are different ways to practice emergency medicine . Neither wrong or more right than the other .. hell, some simultaneously. Look at the whole forest not one or two trees.....

Ridryder 911

[kevkei]

Ridryder, what's with the personal attack and "semantics" and was it directed at me? I'm not going to try to defend myself with your rant if it was, other than to say that I don't have an atomizer to administer anything intranasally, and that I have been in EMS for over 12 years. Our system documentation of skill performance in addition to QA/QI will spit out my success rates, and I can assure you they are stellar. The IV comment was directed at someone else about trying to get a line on a seizing patient and it being impossible, which it is not. And that isn't to suggest inserting an EJ.

[buddha]

Just out of curiosity, Rid, and to rescusitate this horse (or at least to put it on life support), do you have any research on nasal versed? The idea is much more appealing to me than rectal valium, so I asked a friend of mine (D.O.) for his thoughts. He said that versed has been tried before, like most things in medicine, and that it is hit or miss at best for the active seizure. Anecdotally, it seems to sedate some people well while others just seem to not be affected in a desirable manner. I remember a 9 year old psych patient from years ago who was given versed by the attending to sedate his rage. The more he got, the wilder he got. A paradox effect similar to meds like benadryl (which puts adults to sleep but sometimes causes kids to bounce off the walls) or ritalin (which calms kids but causes the opposite effect in young adults). Also, we recently went through a regional debate over benzos when the local psych docs lobbied the REMAC to to scrap valium in favor of ativan. The fact that none of us carry refrigerators on the busses, and the prospect of diluting this nasty drug before administration were both initially overlooked by folks who don't have to work in the streets. Valium finally won out (thank God) and has worked very well for me over the years. Is there new research that indicates versed is better?

[buddha]

Why make it so hard on yourself trying to start an IV in a moving target?? Spread the butt cheeks and feed them a dose of PR valium.

[Ridryder 911]

Buddha, I 'll have to locate the stats & lit... I do know that they had been using nasal Versed for pre-surgical induction on ped's for years. Actually, I believe that is where we got the idea from...

Yeah, I know the rebound thing is pain the gluteus..

I try to find the litreture on nasal versed.. I know we had it for protocol change & review...

Peace,

Ridryder 911

[kemt217]

We have no paramedics to give anti seizure meds or glucagon IM. We would have to give glucagon gel rectally in this case,and drive like hell or as a tech here did in the past ....honey rectally. It is something this tech still gets teased about because after using the honey bear to do this, she set it back on the kitchen table....

[THE_DITCH_DOCTOR]

Ewwww.....funny, but exceedingly gross.....

[Ridryder 911]

new meaning to the saying .. "sweet cheeks".

Be safe,

Ridryder 911

[buddha]

Don't forget that glucose solution and glucagon are two distinct and separate things. Glucagon is a hormone which is injected IM, and stimulates release of the body's own sugar reserve from the liver and other organs. Glucagon does not contain sugar, Kim.

A word of advice - take the needle off the syringe prior to adm PR valium.

And take the tin foil off the suppositories.

[buddha]

The horse is catching a second wind, Steven!!