Seizures RMT - Revision history

JenniferH: /* Seizure Evaluation and Treatment */

2020-11-20T12:40:48Z

Seizure Evaluation and Treatment

← Older revision		Revision as of 12:40, 20 November 2020
Line 26:		Line 26:
	* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.		* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.
	* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.		* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.

			===Resources===
			* [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]]
			* [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]


	[[Emergency RMT Scenarios and Responses]]		[[Emergency RMT Scenarios and Responses]]

JenniferH at 12:39, 20 November 2020

2020-11-20T12:39:02Z

JenniferH at 01:09, 31 August 2019

2019-08-31T01:09:27Z

← Older revision		Revision as of 01:09, 31 August 2019
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	~~'''----------------------------------------------------'''~~
	[[image:All Emergency RMT.png\|750px]]		[[image:All Emergency RMT.png\|750px]]

JenniferH at 01:09, 31 August 2019

2019-08-31T01:09:04Z

@@ Line 1: / Line 1: @@
 '''----------------------------------------------------'''
-===FOR ALL EMERGENCY RMT===
+[[image:All Emergency RMT.png|750px]]
-'''-----------------------------------------'''
+[[media:pediatric critical care guide.pdf|Pediatric Critical Care Guide]]
 ==Seizure Evaluation and Treatment==

JenniferH at 00:23, 23 August 2019

2019-08-23T00:23:29Z

← Older revision		Revision as of 00:23, 23 August 2019
Line 25:		Line 25:

	==Seizure Evaluation and Treatment==		==Seizure Evaluation and Treatment==
	[[file:instaglucose-sb.png\|right\|~~300px~~]]		[[file:instaglucose-sb.png\|right\|350px]]
	* Determine if the patient is still seizing—there may no longer be tonic-clonic movements, but patient may be stiff, have fine tremors, eye deviation (or nystagmus), poor O2 sats, etc.		* Determine if the patient is still seizing—there may no longer be tonic-clonic movements, but patient may be stiff, have fine tremors, eye deviation (or nystagmus), poor O2 sats, etc.
	* Make sure patient is lying down, airway is clear and roll patient on their side if there is vomiting or risk of aspiration		* Make sure patient is lying down, airway is clear and roll patient on their side if there is vomiting or risk of aspiration

JenniferH at 00:21, 23 August 2019

2019-08-23T00:21:37Z

JenniferH at 23:56, 22 August 2019

2019-08-22T23:56:04Z

JenniferH at 23:18, 22 August 2019

2019-08-22T23:18:30Z

← Older revision		Revision as of 23:18, 22 August 2019
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	::* Find out who else is helping the health aide-make sure they call for more help.		::* Find out who else is helping the health aide-make sure they call for more help.
	::* Get at least one more provider to help you with true emergency RMT.		::* Get at least one more provider to help you with true emergency RMT.
	::* Move patient to clinic if they are at home or another site.		::* Move patient to clinic (if able) if they are at home or another site.
	::* Have health aides follow CAB/ABCs.		::* Have health aides follow CAB/ABCs.
	::* Make sure:		::* Make sure:
Line 12:		Line 12:
	:::# Health aides are ready to do CPR if needed.		:::# Health aides are ready to do CPR if needed.
	::* Get all patient’s regular and emergency medications to the clinic.		::* Get all patient’s regular and emergency medications to the clinic.
	::* Activate medevac ASAP if indicated.		::* Activate medevac ASAP if indicated. (May ask another provider to do this while you are working with the health aide.)
	::* Set up video with Vidyo for better patient assessment and to assist with health aide resuscitation.		::* Set up video with Vidyo for better patient assessment and to assist with health aide resuscitation.
	::* Intermittently Reassess/Review/Confirm/Validate what has been done and let health aides know they are doing a good job.		::* Intermittently Reassess/Review/Confirm/Validate what has been done and let health aides know they are doing a good job.
Line 26:		Line 26:
	==Seizure Evaluation and Treatment==		==Seizure Evaluation and Treatment==
	* Determine if the patient is still seizing—there may no longer be tonic-clonic movements, but patient may be stiff, have fine tremors, eye deviation (or nystagmus), poor O2 sats, etc.		* Determine if the patient is still seizing—there may no longer be tonic-clonic movements, but patient may be stiff, have fine tremors, eye deviation (or nystagmus), poor O2 sats, etc.
	* Have a health aide get Instaglucose, Midazolam, Diazepam, and Phenobarbital out of the village clinic lock box and ready for administering.		* Make sure patient is lying down, airway is clear and roll patient on their side if there is vomiting or risk of aspiration
	~~[[file:instaglucose-sb~~.~~png\|right]]~~		* Start O2 if patient is seizing or sats are low.
			* Have a health aide get Instaglucose, Midazolam, Diazepam, and Phenobarbital out of the village clinic lock box and ready for administering. The health aide can take these with them if they are going off site or have someone go back to the clinic to get them if the patient cannot be moved quickly or safely.
	* Have Bag and Mask ready especially for repeat doses of sedating medications		* Have Bag and Mask ready especially for repeat doses of sedating medications
	* Get an Accucheck glucose ASAP (low glucose is a reversible cause of seizures) and continue to monitor glucose.		* Get an Accucheck glucose ASAP (low glucose is a reversible cause of seizures) and continue to monitor glucose.
	* For low or ~~undetectable~~ blood glucose--see village medications doses in boxes to the right.		* For low, undetectable, or unknown (no working glucometer) blood glucose--GIVE GLUCOSE ASAP. (see village medications doses in boxes to the right.)
			[[file:instaglucose-sb.png\|right]]
	* If seizure does not resolve or is prolonged, activate a medevac ASAP.		* If seizure does not resolve or is prolonged, activate a medevac ASAP.
	* Place IV if possible and give NS bolus as appropriate. Remember, hyponatremia is another reversible cause of status epilepticus; giving a NS bolus may help stop the seizure.		* Place IV if possible and give NS bolus as appropriate. Remember, hyponatremia is another reversible cause of status epilepticus; giving a NS bolus may help stop the seizure.
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	* REMEMBER…the longer a patient seizes the harder it is to break the seizure.		* REMEMBER…the longer a patient seizes the harder it is to break the seizure.
	* Before giving benzodiazepines or phenobarbital, make sure the health aide has obtained a good fitting bag and mask and is ready to provide assisted ventilation with bag-mask-valve device to support the patient if the patient becomes apneic. Diazepam can be repeated as often as every 5-15 minutes.		* Before giving benzodiazepines or phenobarbital, make sure the health aide has obtained a good fitting bag and mask and is ready to provide assisted ventilation with bag-mask-valve device to support the patient if the patient becomes apneic. Diazepam can be repeated as often as every 5-15 minutes.
	* ~~Ask for~~ inpatient pharmacist assistance if needed.		* Tiger Text inpatient pharmacist for assistance if needed.
	[[file:midazdose-sb.png]]		[[file:midazdose-sb.png]]
	* Take notes with times, medications given, interventions done, and responses.		* Take notes with times, medications given, interventions done, and responses.

Mfaubion: /* Seizure Evaluation and Treatment */

2019-05-11T00:44:48Z

Seizure Evaluation and Treatment

← Older revision		Revision as of 00:44, 11 May 2019
Line 42:		Line 42:
	* The second line medication will sometimes need be phenobarbital IM. For adults, the dose of IM phenobarb may exhaust the entire village supply!		* The second line medication will sometimes need be phenobarbital IM. For adults, the dose of IM phenobarb may exhaust the entire village supply!
	* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.		* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.
	[[file:ceftriaxone-sm.png\|right]]		[[file:ceftriaxone-sb.png\|right]]
	* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.		* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.

Mfaubion: /* Seizure Evaluation and Treatment */

2019-05-11T00:42:21Z

Seizure Evaluation and Treatment

← Older revision		Revision as of 00:42, 11 May 2019
Line 42:		Line 42:
	* The second line medication will sometimes need be phenobarbital IM. For adults, the dose of IM phenobarb may exhaust the entire village supply!		* The second line medication will sometimes need be phenobarbital IM. For adults, the dose of IM phenobarb may exhaust the entire village supply!
	* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.		* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.
			[[file:ceftriaxone-sm.png\|right]]
	* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.		* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.

← Older revision		Revision as of 12:39, 20 November 2020
Line 12:		Line 12:
	* Have Bag and Mask ready especially for repeat doses of sedating medications		* Have Bag and Mask ready especially for repeat doses of sedating medications
	* Get an Accucheck glucose ASAP (low glucose is a reversible cause of seizures) and continue to monitor glucose.		* Get an Accucheck glucose ASAP (low glucose is a reversible cause of seizures) and continue to monitor glucose.
	* For low, undetectable, or unknown (no working glucometer) blood glucose--GIVE GLUCOSE ASAP. (see village medications doses in boxes to the right.)		* For low, undetectable, or unknown (no working glucometer) blood glucose--GIVE GLUCOSE ASAP. (see village medications doses in boxes to the right. click box to enlarge.)
	* If seizure does not resolve or is prolonged, activate a medevac ASAP.		* If seizure does not resolve or is prolonged, activate a medevac ASAP.
	* Place IV if possible and give NS bolus as appropriate. Remember, hyponatremia is another reversible cause of status epilepticus; giving a NS bolus may help stop the seizure.		* Place IV if possible and give NS bolus as appropriate. Remember, hyponatremia is another reversible cause of status epilepticus; giving a NS bolus may help stop the seizure.
	[[file:midazdose-sb.png\|right\|300px]]		[[file:midazdose-sb.png\|right\|300px]]
	* If a patient has seized for more than 5-10 minutes, be prepared to start with either the patient’s rectal Diastat prescription or the anti-seizure medications in the box below.		* If a patient has seized for more than 5-10 minutes, be prepared to start with either the patient’s rectal Diastat prescription or the anti-seizure medications in the box below (click box to enlarge).
	* REMEMBER…the longer a patient seizes the harder it is to break the seizure.		* REMEMBER…the longer a patient seizes the harder it is to break the seizure.
	* Before giving benzodiazepines or phenobarbital, make sure the health aide has obtained a good fitting bag and mask and is ready to provide assisted ventilation with bag-mask-valve device to support the patient if the patient becomes apneic. Diazepam can be repeated as often as every 5-15 minutes.		* Before giving benzodiazepines or phenobarbital, make sure the health aide has obtained a good fitting bag and mask and is ready to provide assisted ventilation with bag-mask-valve device to support the patient if the patient becomes apneic. Diazepam can be repeated as often as every 5-15 minutes.
Line 26:		Line 26:
	* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.		* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.
	* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.		* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.


			[[Emergency RMT Scenarios and Responses]]

← Older revision		Revision as of 00:21, 23 August 2019
Line 25:		Line 25:

	==Seizure Evaluation and Treatment==		==Seizure Evaluation and Treatment==
	[[file:instaglucose-sb.png\|~~thumb~~\|300px]]		[[file:instaglucose-sb.png\|right\|300px]]
	* Determine if the patient is still seizing—there may no longer be tonic-clonic movements, but patient may be stiff, have fine tremors, eye deviation (or nystagmus), poor O2 sats, etc.		* Determine if the patient is still seizing—there may no longer be tonic-clonic movements, but patient may be stiff, have fine tremors, eye deviation (or nystagmus), poor O2 sats, etc.
	* Make sure patient is lying down, airway is clear and roll patient on their side if there is vomiting or risk of aspiration		* Make sure patient is lying down, airway is clear and roll patient on their side if there is vomiting or risk of aspiration
Line 35:		Line 35:
	* If seizure does not resolve or is prolonged, activate a medevac ASAP.		* If seizure does not resolve or is prolonged, activate a medevac ASAP.
	* Place IV if possible and give NS bolus as appropriate. Remember, hyponatremia is another reversible cause of status epilepticus; giving a NS bolus may help stop the seizure.		* Place IV if possible and give NS bolus as appropriate. Remember, hyponatremia is another reversible cause of status epilepticus; giving a NS bolus may help stop the seizure.
	[[file:midazdose-sb.png\|~~thumb~~\|300px]]		[[file:midazdose-sb.png\|right\|300px]]
	* If a patient has seized for more than 5-10 minutes, be prepared to start with either the patient’s rectal Diastat prescription or the anti-seizure medications in the box below.		* If a patient has seized for more than 5-10 minutes, be prepared to start with either the patient’s rectal Diastat prescription or the anti-seizure medications in the box below.
	* REMEMBER…the longer a patient seizes the harder it is to break the seizure.		* REMEMBER…the longer a patient seizes the harder it is to break the seizure.
Line 43:		Line 43:
	* Get Vidyo set up for monitoring if not done already if seizure management is ongoing.		* Get Vidyo set up for monitoring if not done already if seizure management is ongoing.
	* The second line medication will sometimes need be phenobarbital IM. For adults, the dose of IM phenobarb may exhaust the entire village supply!		* The second line medication will sometimes need be phenobarbital IM. For adults, the dose of IM phenobarb may exhaust the entire village supply!
	[[file:ceftriaxone-sb.png\|~~thumb~~\|300px]]		[[file:ceftriaxone-sb.png\|right\|300px]]
	* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.		* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.
	* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.		* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.

← Older revision		Revision as of 23:56, 22 August 2019
Line 25:		Line 25:

	==Seizure Evaluation and Treatment==		==Seizure Evaluation and Treatment==
			[[file:instaglucose-sb.png\|thumb\|300px]]
	* Determine if the patient is still seizing—there may no longer be tonic-clonic movements, but patient may be stiff, have fine tremors, eye deviation (or nystagmus), poor O2 sats, etc.		* Determine if the patient is still seizing—there may no longer be tonic-clonic movements, but patient may be stiff, have fine tremors, eye deviation (or nystagmus), poor O2 sats, etc.
	* Make sure patient is lying down, airway is clear and roll patient on their side if there is vomiting or risk of aspiration		* Make sure patient is lying down, airway is clear and roll patient on their side if there is vomiting or risk of aspiration
Line 30:		Line 31:
	* Have a health aide get Instaglucose, Midazolam, Diazepam, and Phenobarbital out of the village clinic lock box and ready for administering. The health aide can take these with them if they are going off site or have someone go back to the clinic to get them if the patient cannot be moved quickly or safely.		* Have a health aide get Instaglucose, Midazolam, Diazepam, and Phenobarbital out of the village clinic lock box and ready for administering. The health aide can take these with them if they are going off site or have someone go back to the clinic to get them if the patient cannot be moved quickly or safely.
	* Have Bag and Mask ready especially for repeat doses of sedating medications		* Have Bag and Mask ready especially for repeat doses of sedating medications
	* Get an Accucheck glucose ASAP (low glucose is a reversible cause of seizures) and continue to monitor glucose.		* Get an Accucheck glucose ASAP (low glucose is a reversible cause of seizures) and continue to monitor glucose.
	* For low, undetectable, or unknown (no working glucometer) blood glucose--GIVE GLUCOSE ASAP. (see village medications doses in boxes to the right.)		* For low, undetectable, or unknown (no working glucometer) blood glucose--GIVE GLUCOSE ASAP. (see village medications doses in boxes to the right.)
	~~[[file:instaglucose-sb.png\|right]]~~
	* If seizure does not resolve or is prolonged, activate a medevac ASAP.		* If seizure does not resolve or is prolonged, activate a medevac ASAP.
	* Place IV if possible and give NS bolus as appropriate. Remember, hyponatremia is another reversible cause of status epilepticus; giving a NS bolus may help stop the seizure.		* Place IV if possible and give NS bolus as appropriate. Remember, hyponatremia is another reversible cause of status epilepticus; giving a NS bolus may help stop the seizure.
			[[file:midazdose-sb.png\|thumb\|300px]]
	* If a patient has seized for more than 5-10 minutes, be prepared to start with either the patient’s rectal Diastat prescription or the anti-seizure medications in the box below.		* If a patient has seized for more than 5-10 minutes, be prepared to start with either the patient’s rectal Diastat prescription or the anti-seizure medications in the box below.
	* REMEMBER…the longer a patient seizes the harder it is to break the seizure.		* REMEMBER…the longer a patient seizes the harder it is to break the seizure.
	* Before giving benzodiazepines or phenobarbital, make sure the health aide has obtained a good fitting bag and mask and is ready to provide assisted ventilation with bag-mask-valve device to support the patient if the patient becomes apneic. Diazepam can be repeated as often as every 5-15 minutes.		* Before giving benzodiazepines or phenobarbital, make sure the health aide has obtained a good fitting bag and mask and is ready to provide assisted ventilation with bag-mask-valve device to support the patient if the patient becomes apneic. Diazepam can be repeated as often as every 5-15 minutes.
	* Tiger Text inpatient pharmacist for assistance if needed.		* Tiger Text inpatient pharmacist for assistance if needed.
	~~[[file:midazdose-sb.png]]~~
	* Take notes with times, medications given, interventions done, and responses.		* Take notes with times, medications given, interventions done, and responses.
	* Get Vidyo set up for monitoring if not done already if seizure management is ongoing.		* Get Vidyo set up for monitoring if not done already if seizure management is ongoing.
	* The second line medication will sometimes need be phenobarbital IM. For adults, the dose of IM phenobarb may exhaust the entire village supply!		* The second line medication will sometimes need be phenobarbital IM. For adults, the dose of IM phenobarb may exhaust the entire village supply!
			[[file:ceftriaxone-sb.png\|thumb\|300px]]
	* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.		* If you think there is any chance that the seizure is from infection-Don’t forget to give Ceftriaxone.
	~~[[file:ceftriaxone-sb.png\|right]]~~
	* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.		* Any emergency RMT requiring a medevac needs to be communicated to the ER physician and PTO completed.