Seizures and 12 lead

crashh

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Do your protocols require you to get a 12 lead for every seizure call?
 

mycrofft

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I don't have protocols. I'm retired.:cool:

But…many calls we were dispatched to described by the caller as a seizure turned out to be lots of other things. Temporary cerebral hypoxia, be it vasovagal syncope, PAT or "etc", can potentially cause the "funky chicken" response to occur. (I always wondered if only some people did that because they were more prone to seizures for some reason or what…). have also been sent to "seizures" and it turned out to be early childbirth contractions, severe coughing jags, drug overdose, and just plain being driven to inarticulate fury by an argumentative domestic partner (a good time to stay out of the kitchen and have the firearms hidden).

Can't hurt, might help document something transient the ED can use.
 
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AeroClinician

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If a pt complained of chest pain/dizziness/xyz anginal equvlent, passed out hit head on ground. Then had a seizure, I will do a 12-lead.

It also could be used to look for possible electrolyte abnormalities causing the seizure.
 
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mycrofft

Still crazy but elsewhere
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If a pt complained of chest pain/dizziness/xyz anginal equvlent, passed out hit head on ground. Then had a seizure, I will do a 12-lead.

It could be used to look for possible electrolyte abnormalities causing the seizure.

How about a chem panel? Could you start electrolytes based on a seizure and an atypical EKG? Which electrolyte imbalance would cause a seizure and be diagnosed and treated within protocols based upon an EKG?
 

unleashedfury

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12 Leads are not required per seizure protocol but define seizures.. Is it a person with a history of epilepsy or a seizure disorder?

Or is it a head injury?

Doing a 12 lead won't hurt anyone, and it sure doesn't take long. But I am a strong believer in that a Patient history and HPI can often lead to a clinical diagnosis....
 

Handsome Robb

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12 Leads are not required per seizure protocol but define seizures.. Is it a person with a history of epilepsy or a seizure disorder?

Or is it a head injury?

Doing a 12 lead won't hurt anyone, and it sure doesn't take long. But I am a strong believer in that a Patient history and HPI can often lead to a clinical diagnosis....

While I agree that a 12-lead really can't hurt anyone, unless they're really hairy...there's no real indication for it except in situations like Aero presented.

Personally I don't think a Sz in a patient with a known Sz disorder and who doesn't want to go to the hospital should be an ALS call. Hell even if they do want to go I don't understand why a Paramedic has to attend the call. No history of though and you bet your *** I'm sitting back there even if I'm not required to.

Per our protocols anyone that has a "seizure" has to go on the monitor, hence an "ALS" call. No requirement for 12-lead.
 

Milla3P

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OP, is this a state/county/local protocol or an employer protocol? This SMACKS of billing purposes to me.
 

Aprz

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How about a chem panel? Could you start electrolytes based on a seizure and an atypical EKG? Which electrolyte imbalance would cause a seizure and be diagnosed and treated within protocols based upon an EKG?
Hypercalcemia (shortened QT interval), hypocalcemia (prolonged QT interval), hyponatremia, and hypomagnesium (torsades de pointes) are the ones I'd guess. I don't believe hyponatremia would appear on the EKG. I wouldn't be confident enough in the EKG to diagnose hypercalcemia or hypocalcemia. I would treat torsades de points with 2 gm of MgSO4 IV over several minutes.

Can hypocalcemia also cause R-on-T Phenomenon due to prolonged QT interval?

Not EKG, but could look for trousseau's sign and chvostek's sign for hypocalcemia.

What about an arrhythmia that decreasing blood flow to the brain?

A pulmonary embolism can present as a seizure (the famous S1Q3T3, which is a sign of right ventricular enlargement, retrograde T-waves in the inferior and anteroseptal leads, ST depression in the anteroseptal leads, right axis deviation due to the right ventricular enlargement, tachycardia).

Intracranial hemorrhage could cause a seizure (deep retrograde symmetrical T-waves).

I don't think obtaining a 12-lead on a seizure patient is unreasonable. Even if they have history of epilepsy, why jump straight to conclusion without further investigation?
 
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Christopher

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Hypercalcemia (shortened QT interval), hypocalcemia (prolonged QT interval),

Minor nit, shortened ST segment and lengthened ST segment, producing a visual lengthening of the QTi. However, it doesn't look the same as a traditionally shortened QT or prolonged QT.

Can hypocalcemia also cause R-on-T Phenomenon due to prolonged QT interval?

Usually not, as you don't have the same excitability without the Ca2+ available. Loss of delayed afterdepolarizations / "phase 2 reentry".

Intracranial hemorrhage could cause a seizure (deep retrograde symmetrical T-waves).

They're all retrograde :) I think you mean inverted.

I don't think obtaining a 12-lead on a seizure patient is unreasonable. Even if they have history of epilepsy, why jump straight to conclusion without further investigation?

I obtain one on all unknown cause seizures, or on a known cause seizure that seems "off".
 
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crashh

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I'm a new paramedic...i can't wait until I know EKGs in such depth as some of you do! :)
 

STXmedic

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I'm a new paramedic...i can't wait until I know EKGs in such depth as some of you do! :)

Knowing ECGs as well as Christopher or some of the other guys here won't come from experience. You'll need to go out of your way in studying and learning to get even near their proficiency. Start reading ;)
 

Aprz

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Carlos Danger

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I don't think obtaining a 12-lead on a seizure patient is unreasonable. Even if they have history of epilepsy, why jump straight to conclusion without further investigation?

I agree it isn't unreasonable, but I'm not a supporter of doing things just because "it won't hurt". I think even cheap, seemingly harmless over-testing brings with it difficult-to-predict unintended consequences and costs that in the long run, over a large number of patients, can cause more harm than they prevent. And I think in a seizure patient, the chances are very slim of finding something conclusive and treatable with a prehospital EKG.

IME, seizures have a readily identifiable cause 95% of the time. Usually it is a history of epilepsy. Other times it's toxicity or head trauma or a SAH which is almost always associated with tell tale signs and symptoms.
 

ParamedicStudent

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I heard of a story of a medic intern doing a 12-lead on someone c/c of a headache only. 12-lead showed STEMI. Perhaps they were really lucky to have caught that? But do your guy's protocols say do a 12-lead with an active seizure? Or postictal ?
 

StCEMT

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I heard of a story of a medic intern doing a 12-lead on someone c/c of a headache only. 12-lead showed STEMI. Perhaps they were really lucky to have caught that? But do your guy's protocols say do a 12-lead with an active seizure? Or postictal ?
It doesn't surprise me that something seemingly random could be a sign of a STEMI. In much older (like in their 80's) patients, you don't get the typical complaint of chest pain as often.

As far as the seizures go, I don't think I would run a 12 lead if I had a pt with a known history unless something else stood out that made me think I had to.
 

gotbeerz001

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Increased ICP due to a massive bleed can cause ST elevation and mimic a STEMI. If you have headache, n/v, seizures (with no hx of sz) and ST elevation, a bleed would be pretty high on my list... especially absent common cardiac symptoms.


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