ERDoc Posted April 21, 2006 Share Posted April 21, 2006 You are called to the house of a 43 y/o female who has been seizing for the last 10 minutes. The son is running around the house like he is looking for something but can't find it. The daughter is at the pts side, crying, saying, "Mommy don't die!!" The husband is leaning over the pt saying, "Damn, I never seen anything like this before. Can you guys do something to make her stop?" What do you do? Link to comment Share on other sites More sharing options...
chbare Posted April 21, 2006 Share Posted April 21, 2006 What is my general impression, is the patient currently having a seizure and what does it look like? Is there a patent airway and does she have a pulse? What is the son looking for? Thank you, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted April 21, 2006 Author Share Posted April 21, 2006 What is my general impression, is the patient currently having a seizure and what does it look like? Is there a patent airway and does she have a pulse? What is the son looking for? Thank you, chbare. The seizure is gneralized/clonic-tonic/grand mal (take your pick). She is foaming at the mouth and you her gurgling sounds. There is a good, strong pulse. The son is not looking for anything in particular, he just doesn't have anything else to do. Link to comment Share on other sites More sharing options...
akroeze Posted April 21, 2006 Share Posted April 21, 2006 Charging to 360.... Link to comment Share on other sites More sharing options...
EMS_Cadet Posted April 21, 2006 Share Posted April 21, 2006 "Damn, I never seen anything like this before." This *almost* gives me the impression that this patient has a history of seizures... Link to comment Share on other sites More sharing options...
jw-c152 Posted April 21, 2006 Share Posted April 21, 2006 For starters, place her in a lateral position and insert OPA to help maintain airway (NPA if the OPA won't work d/t the seizure). High concentration O2. Meanwhile gathering some history on the patient. Does she have Hx of seizures? If yes, what meds does she take for them and has she been given anything during this episode to stop the seizure. Other Med Hx and Rx. Is pt pregnant? Any allergies. Anything in the room to give an indication of what could be causing the seizure if no Hx of seizures (ie. drugs/alcohol/etc). Find out from husband how much the pt weighs. Who wants to take it from here? Link to comment Share on other sites More sharing options...
AZCEP Posted April 21, 2006 Share Posted April 21, 2006 Following the O2 admin as above, vascular access if possible, followed by the BZD of choice. As much history as possible, BGL, list of meds/allergies/PMHx Link to comment Share on other sites More sharing options...
chbare Posted April 21, 2006 Share Posted April 21, 2006 Any history of trauma. I agree AZCEP, if there are no contraindications from history or meds we need to stop the seizure with benzo's. If this patient has actually been seizing for 10 minutes non stop, she's headed for status epilepticus. May want to have airway and RSI equipment ready. Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted April 21, 2006 Author Share Posted April 21, 2006 The husband says that she has never had seizures before and there is no history of trauma, although she is recently from Central America and did not have much medical care there. The family also says that the pt does not drink, smoke or take any illegal drugs. She has not been sick recently. She was sitting at the dinner table talking with the family and just fell over and seized. There are no known allergies. As far as the husband knows she is not pregnant, "But I guess anything could be possible." The pt weighs about 180 lbs (sorry my Canadian friends). Her FS is 134. You put in an NPA and start an IV. You give your benzo and get no response. What do you do now? Is there anything else you want to know? Link to comment Share on other sites More sharing options...
AZCEP Posted April 21, 2006 Share Posted April 21, 2006 If we can't get the seizure controlled, we need to look at RSI so we can provide some oxygen for the brain to use. How long was she out of the country? Rashes, petechia, purpura, skin discolorations? Link to comment Share on other sites More sharing options...
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