BLS Seizure?

[MrBrown]

You seem a bit passive aggressive. That overreaction was remarkable.

I'll rephrase in order to avoid another outburst. Does every seizure patient require an IV?

Remarkable, no. IV on every seizure, no.

 

[boingo]

OMG there is no such #*T%*#(%(ING thing as a "BLS" seizure or an "ALS" seizure or any other kind of "_LS" seizure!

You people are your obsession with BLS vs ALS OMG it makes me so angry it's so painful to keep hearing it, my bleeding ears!

Would a seizure here get an Intensive Care Paramedic? Depends, if it's a known seizure history or one simple seizure that is uncomplicated then no it wouldn't but should it be multiple or unceasing seizures then yes.

In the year or two one of the skills we will probably bring down to Paramedic level (sub-ALS) is midazolam IM and IN for seizures. Australia already has it in some states.

A patient with a known seizure history who has recovered can be left at home here.

FWIW, your angst regarding BLS v.s. ALS is a bit misplaced, it seems you have a varying level of prehospital providers as well, no? Your choice of words differs, but essentially its the same, BLS level providers operate at a lower level and skillset than ALS, you can call it Intensive Care Paramedic, Basic Care Paramedic, Critical Care Paramedic, or whatever you like.

 

[MrBrown]

FWIW, your angst regarding BLS v.s. ALS is a bit misplaced, it seems you have a varying level of prehospital providers as well, no?

I don't want to hijack this dude's threat and turn this into a pissing match but the misplaced notion that intravenous cannulation is somwhow "advanced" prehospital care is absurd.

Now I can regonise systemic differences but when somebody says "oh an IV is advanced" it makes me cringe.

Yes we have different levels of provider however the reality is that we do not have the vast gap between skillsets unlike in some parts of the world and that "BLS" and "ALS" are more closely aligned.

As has been said on here before, it's the American "BLS vs ALS" that makes that whole notion so hillariously ridiculous.

The following are interventions that cannot be performed by anybody in New Zealand but an Intensive Care Paramedic (ALS):

- Intubation
- Thrombolysis
- Atropine
- Amiodarone
- Intraossous
- Frusemide (probably going to be withdrawn)
- Ketamine
- Turkel chest decompression

Notice how that doesn't include things like adrenaline, IV fluid, 12 lead ECG interpretation, and all other drugs? Those things are not ALS interventions here and those who are "Intensive Care" Officers perform complex autonomous management with advanced medications often on very sick patients.

This is why midazolam is looking to be bought down from an ALS skill to a Paramedic skill because 1) it increases its avaliability, 2) reduces the number of backup requests purely for midazolam, 3) keeps ALS free for truly complex medical emergencies, 4) allows more efficent use of resources and most importantly 5) allows for early management and treatment of the status epilepticus patient which would otherwise have to wait for ALS.

My point is not to shake my Johnson and go off on a tangent but rather to say that a bit of midaz for Sam who dad found having the tonic clonic's on the floor and off to hospital should not be an "advanced procedure".

It seems that too many people regard "ALS" as simply being about "skills" rather than the base of knowledge and clinical ability that provider should have and it just drives me bonkers.

And now, back to your regularly scheduled thread.

*Brown away h34r:

 

[Hastings]

I am so depressed with what people STILL continue to do with the most basic of threads. It's why I got completely turned off and left in the first place. Most of the time, when someone brings up the terms "BLS" or "ALS" they aren't trying to start some philosophical discussion. It's simply a division in what procedures are required. An IV in many locations is considered an ALS procedure. Thus, starting an IV would make that call an ALS call. If you're just transporting with vitals, that would be considered a BLS call.

P.S. The man who posted this thread is from America. Don't go on a tirade about some New Zealand way of doing things (in the context of how any other way is ridiculous).

 

[Hastings]

On a serious note, this place hasn't changed much. I return after a lengthy time away only to come back and have someone start an unprovoked argument about BLS/ALS in a thread that asked a question as simple as "do all seizure patients require an IV?"

I hope you're drawing in a ton of new members, because I imagine the turnover must be as devastating now as it was back when I was a new medic attempting to learn how to become better (and watching everyone with similar intent getting derailed and degraded in the same manner as above).

 

[MMiz]

On a serious note, this place hasn't changed much. I return after a lengthy time away only to come back and have someone start an unprovoked argument about BLS/ALS in a thread that asked a question as simple as "do all seizure patients require an IV?"

I hope you're drawing in a ton of new members, because I imagine the turnover must be as devastating now as it was back when I was a new medic attempting to learn how to become better (and watching everyone with similar intent getting derailed and degraded in the same manner as above).

Your post has been moved back where it belongs. If you find MrBrown's posts condescending, I'd have to agree. I have to admit that these days I rarely read his posts because of it.

This is an online discussion forum, where every member is an expert, and every post is sure to offend half of the community's membership. Welcome back to EMTLife!

 

[usafmedic45]

This is an online discussion forum, where every member is an expert, and every post is sure to offend half of the community's membership. Welcome back to EMTLife!

Well said Matt.

 

[Aidey]

Do I start an IV on every single seizure patient? No, I do not. It completely depends on the situation. Do I transport every single seizure patient? Again, no, it depends on the situation.

Generally first time seizures and seizures in patients with suspected drug/medication ingestion always get an IV. Also seizures in the presence of another medical condition, like sepsis, hypoxia, hypoglycemia or trauma (Hopefully that didn't need to be specified).

With patients who have a history of seizures I will usually start an IV if the following circumstances apply.

1. They have not had a seizure for an extended period of time.
2. They have had a recent medication change, and take one of the meds where levels can be checked, like Depakote or Dilantin. In that case the IV is more for the labs than actual IV access.
3. The pt has a history of status seizures, or a history of cluster seizures (ie, they never only seize once).


Legally, anyone who can answer the questions and isn't a threat to themselves or someone else can refuse, so yes, not all seizure pts get transported. If the patient has a known history of seizures I am more likely to spend a little extra time on scene waiting for their postictal period to lapse so I can speak with them and find out what they want. If their postictal period is sustained we will transport. Also, if someone who knows the pt is on scene and telling us something is different we'll go ahead and transport without waiting for the pt to come to.

I have occasionally gotten permission to not transport known seizure patients who are still postictal but are in the care of their parent/spouse/caregiver/whatever. However, I have only ever done that when the parent/spouse/caregiver is requesting no transport.

 

[Hastings]

I'll give you the basic scenario. Get called Priority 1 for a 25 y/o male, had a seizure in the shower, door to bathroom locked. Downgraded to priority 3 by FD on scene. Arrive on scene to find the patient sitting on the couch. Awake, alert, oriented. Pt states he has had idiopathic seizures for 10 years, states they last no more than 5-10 seconds, used to be controlled by medications but he can no longer afford them. So the patient has a seizure while having this shower, came out of it, finished the shower, got dressed, opened the locked door, and was going about his chores when FD arrived. Pt isn't injured and has no complaints. Pt didn't necessarily believe he needed to go to the hospital, but we told him we'd be happy to take him in to talk to someone about getting the medication that he needs. He agrees, is ambulatory to ambulance and into the ER. I did not start an IV. The nurse was furious.

 

[Melclin]

IM midaz works pretty much just as well as a first line invention as I understand it. If he had a seizure without an IV in, terminate it with IM midaz. Problem solved.

IN is another option.

 

[MrBrown]

... I did not start an IV. The nurse was furious.

Did she say why at all?

 

[Stew]

Hastings, I wouldn't have gained IV access if it were me. What is the point? Fully conscious and alert, nil reversible causes found on examination which would require an IV treatment, transporting for more of a 'social' reason (info regarding medication availability).
From my current protocols I'd only be permitted to administer IM midazolam if he started again anyway.

edit- answer to the original question, no. Not all of my seizure patients get an IV.

 

[reaper]

Remember one thing. You don't work for the Nurse. Let her be furious all day long. You make your own decisions on scene. I cannot stand any medic that starts a line on a pt, just because they are afraid the nurses will yell, if they don't.

I start Iv's because I need them. I do not start courtesy Iv's for the Nurses.

 

[Aidey]

I start Iv's because I need them. I do not start courtesy Iv's for the Nurses.

I agree. We don't carry IV locks, which is primarily what the hospitals like to have. When I start an IV it is because either I anticipate needing it, or I anticipate that the pt will receive IV meds very soon after arriving at the hospital. For example, and asthma pt who is probably going to get IV steroids.

I've actually not done IVs on some patients who I know will get one at the hospital on purpose. Namely, patients who I have a very very strong suspicion they will be doing blood cultures on. If I start an IV they have to poke the patient a second time since they can't draw cultures off an existing IV. Why subject the pt to multiple IV sticks when I won't be using the IV myself?

 

[MDewell]

...I do not start courtesy Iv's for the Nurses.

I was going to say something to this affect after reading the thread, but I was beaten to it.

That reminds me..I can tell you from horror stories around here that nursing home nurses will tend to call for an ambulance for patient who's not responsive, and when the crew arrives, finds the patient had to have been gone for awhile. Turns out, nurses around here do this so they don't have to do the paperwork...they leave it to someone else. I wonder how often that happens around the world.

Didn't mean to hijack the thread for a second...I'll scurry back off to my world.

Great thread BTW.