Guest guest Posted January 18, 2007 Report Share Posted January 18, 2007 In a message dated 1/18/2007 10:50:59 AM Central Standard Time, rknappage2001@... writes: I recently heard a medic make the comment that Ativan/Versed does not stop the brain from seizing it only stops the muscle activity and the meds will not prevent a patient from having a second seizure. All comments are welcomed on this one. Chuckle...a medic that was recently trained with RSI, I take it? Depressant medications (benzos, barbs, even alcohol) and specific membrane stabilizing agents ('anticonvulsants') all increase the brain's seizure threshold by one of several central actions. Where the problem comes in is where a patient receives RSI followed by continued paralysis to provide an adequate air way- the paralytics stop the *outward manifestations* of a seizure, but do nothing for the continued cerebral hyperactivity. If the benzodiazapine medications are not continued along with the paralysis, then brain damage can continue to accrue. Considering that most patients who are conscious and paralyzed end up in rather a panicked, hyperacute state anyway, I'd have to review carefully any patient who underwent field RSI but did not continue to receive appropriate sedation along with continued paralysis. Where possible, I prefer Diprovan (propofol, 'milk of amnesia') as it's well tolerated, has a fast onset of action, short residual when stopped and is easily titrated for most situations. Interestingly enough, there are several articles out in the literature that indicate that Diprovan (propofol) is safe and effective to use as a sedating agent in status epilepticus, as long as certain cautions are observed. In particular, a 2005 article on Medscape observes: <block quote> " The present study raises the possibility that propofol should be used as primary therapy for status epilepticus in children and underscores the need for a systematic, prospective study in this population, " write Nina F. Schor, MD, PhD, and J. Riviello, Jr., MD, in an accompanying editorial. " However, its retrospective, sequential, historical design precludes definitive conclusions regarding efficacy. " Dr. Schor is affiliated with the Division of Child Neurology at Children's Hospital of Pittsburgh, Pennsylvania. Dr. Riviello is affiliated with critical care neurology service at Children's Hospital of Boston and the Department of Neurology at Harvard Medical School, Boston, Massachusetts. Noting that propofol can be associated with metabolic acidosis and cardiac collapse, the editorialists stress that the drug be used with caution and that the infusion rate should be no more than 67 µg per kg per minute. (1) </block quote> Other complications include rhabodomyolysis and increased triglyceride levels, however, the article concludes that, within those caveats, 'milk of amnesia' is safer enough than thiopental that it should be considered as a primary agent prior to going to a barbiturate coma. ck S. Krin, DO (1) _http://www.medscape.com/viewarticle/511184_ (http://www.medscape.com/viewarticle/511184) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2007 Report Share Posted January 18, 2007 I recently heard a medic make the comment that Ativan/Versed does not stop the brain from seizing it only stops the muscle activity and the meds will not prevent a patient from having a second seizure. All comments are welcomed on this one. Stay Safe. Knappage EMT/P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2007 Report Share Posted January 18, 2007 Not true. Benzodiazepines slow or stop the seizure activity in the cortex by affecting the GABA receptors in the brain. Neuromuscular blockers are sometimes given for refractory seizures. In that case, the muscle activity stops but the electrical activity in the brain persists. _____ From: texasems-l [mailto:texasems-l ] On Behalf Of BULL Sent: Thursday, January 18, 2007 10:46 AM To: texasems-l Subject: Seizure Question I recently heard a medic make the comment that Ativan/Versed does not stop the brain from seizing it only stops the muscle activity and the meds will not prevent a patient from having a second seizure. All comments are welcomed on this one. Stay Safe. Knappage EMT/P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2007 Report Share Posted January 18, 2007 Thank you,sir. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2007 Report Share Posted January 18, 2007 Hey Bull, Heard something similar one night teaching where a student asked why we do not treat a patient with Ativan/Versed after the first Siezure to prevent a second. I kinda wondered if I did a poor job explaing when to treat Siezure, Only Active or Profolactic treatment... Would love someone to commment on weather or not Benzo's prevent a second after the first one ends and should medics treat even if the Siezure has stopped prior to or at Medics arrival.... W BULL wrote: I recently heard a medic make the comment that Ativan/Versed does not stop the brain from seizing it only stops the muscle activity and the meds will not prevent a patient from having a second seizure. All comments are welcomed on this one. Stay Safe. Knappage EMT/P --------------------------------- Never miss an email again! Yahoo! Toolbar alerts you the instant new Mail arrives. Check it out. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2007 Report Share Posted January 18, 2007 Benzos will prevent subsequent seizures. The only reason to treat seizures in the field is status epilepticus. Thus, do not prophylactically give Benzos to treat a possible second seizure. BEB _____ From: texasems-l [mailto:texasems-l ] On Behalf Of Weinzapfel Sent: Thursday, January 18, 2007 11:53 PM To: texasems-l Subject: Re: Seizure Question Hey Bull, Heard something similar one night teaching where a student asked why we do not treat a patient with Ativan/Versed after the first Siezure to prevent a second. I kinda wondered if I did a poor job explaing when to treat Siezure, Only Active or Profolactic treatment... Would love someone to commment on weather or not Benzo's prevent a second after the first one ends and should medics treat even if the Siezure has stopped prior to or at Medics arrival.... W BULL <rknappage2001@ <mailto:rknappage2001%40yahoo.com> yahoo.com> wrote: I recently heard a medic make the comment that Ativan/Versed does not stop the brain from seizing it only stops the muscle activity and the meds will not prevent a patient from having a second seizure. All comments are welcomed on this one. Stay Safe. Knappage EMT/P --------------------------------- Never miss an email again! Yahoo! Toolbar alerts you the instant new Mail arrives. Check it out. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2007 Report Share Posted January 18, 2007 In a message dated 1/18/2007 11:55:06 PM Central Standard Time, ctacdoc657@... writes: Hey Bull, Heard something similar one night teaching where a student asked why we do not treat a patient with Ativan/Versed after the first Siezure to prevent a second. I kinda wondered if I did a poor job explaing when to treat Siezure, Only Active or Profolactic treatment... Would love someone to commment on weather or not Benzo's prevent a second after the first one ends and should medics treat even if the Siezure has stopped prior to or at Medics arrival.... W The general answer is no, if there is no seizure activity at the time of ALS arrival, there is no indication to give benzodiazapines at that time. Supportive care (airway, oxygen, etc.) and transport for evaluation is the order of the day. High Speed Diesel Bolus generally is not needed. ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
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