I teased the new seizure protocols a few weeks back in discussing the updated head trauma protocols, and guess what? Your patience has been rewarded! We have two separate seizure protocols to talk about, so let’s start with the one for adults.
As in all things, ABCs are a priority here, with emphasis at the CFR level on avoiding OPAs in favor of NPAs if possible, considering the risk of aspiration. BLS will address any hypoglycemia while requesting ALS backup as needed. And ALS will manage active seizures with one of three benzodiazepines (IV/IM/IN as available) – midazolam, lorazepam, or diazepam, each as Standing Order, with an SO for a single repeat dose of whichever they used, if needed. OLMC will be contacted if additional sedation beyond the two SO doses is needed, so be prepared for those calls for your stat ep patients.
Remember that status epilepticus is extraordinarily time sensitive, so do what you can to safely help EMS manage these critical patients. Also keep in mind, as the key points section mentions, that relative hypoglycemia in your diabetic patients may be a precipitating factor, so make sure you ask about those fingersticks!
Stay tuned for the peds spin on seizures next week! Until then, www.nycremsco.org or the protocols binder for more.
Dave