10 minutes and no emergency meds for seizure

Specialties School

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We have a kid that has had seizures all school year. He supposedly has a pediatric neurologist, but his seizure plan states that we are to call 911 for seizures lasting more than 10 minutes. Does this seem long to you? And odd that we don't have any meds for breakthrough seizures?

Its been a stress for all of us because he has a seizure daily. Mom is uncooperative in communicating diagnoses with us and care plans. She finally brought in the seizure action plan yesterday and we learned that he has a diagnosis of aspergers! Mom does not want EMS called. Would most schools put up with this? I am new to school nursing and don't know the norm!

I have patients pretty frequently that their home diastat prescription (and their PRN while inpatient) is for greater than 10 minutes. These are kids that are pretty regularly seizing and would be getting diastat constantly if it was less than 10 minutes. So it's not a totally outlandish plan.

Specializes in BNAT instructor, ICU, Hospice,triage.

Child protective services are involved. We are thinking that the mom must be hiding something, is the reason she will not authorize us to talk with her child's doctors. The seizure action plan was signed by the pediatric neurologist but mom had the action plan mailed to her house and then we are worried that she may have added info to it and then gave us a copy of it. It seems so long to wait 10 minutes. On the other hand, these are not full blown grand mal seizures, they are usually partial complex. Would that make a difference?

Specializes in BNAT instructor, ICU, Hospice,triage.

But the MD has not ordered any diastat or any meds for breakthrough seizures. I would be more comfortable if we had breakthrough seizure meds. Maybe they don't trust the family with these meds are drug seekers meds? I don't know.

Specializes in BNAT instructor, ICU, Hospice,triage.
Perhaps the reason the mom is reluctant is that this is not a seizure disorder at all. Perhaps the child has pseudo seizures---hence the lack of rescue medication, the 10 minute time frame for calling ems, the mom's unwillingness to cooperate. Some times there seems to be a stigma with pseudoseizure patients, and this mom is probably on the defensive. I would ask her point blank if these are pseudo seizures.

I believe that they very well could be pseudo seizures. The seizure meds that he has been on have not helped. He clearly needs some help in finding a way to learn to cope. He cries because he wants to be homeschooled, wants mom to come and pick him up. Even though they appear to be psychogenic instead of electrical, they are still real. His pupils become dilated and he is unconscious at times and other times he is in and out of consciousness. Sometimes when I comment to the principal or someone else during a seizure, "He is moving his right hand, I haven't seen him move anything else". THen he all of a sudden starts moving other body parts. Seems a little odd at times. But The pediatric neurologist signed a letter that stated that he was having complex partial seizures. (could a complex partial seizure still be a pseudo or psychogenic seizure?) Again, we are suspicious that mom could have altered the letter because she is embarassed or hiding something. Mom has refused to allow our school counselor to help him.

Specializes in Pedi.
I believe that they very well could be pseudo seizures. The seizure meds that he has been on have not helped. He clearly needs some help in finding a way to learn to cope. He cries because he wants to be homeschooled, wants mom to come and pick him up. Even though they appear to be psychogenic instead of electrical, they are still real. His pupils become dilated and he is unconscious at times and other times he is in and out of consciousness. Sometimes when I comment to the principal or someone else during a seizure, "He is moving his right hand, I haven't seen him move anything else". THen he all of a sudden starts moving other body parts. Seems a little odd at times. But The pediatric neurologist signed a letter that stated that he was having complex partial seizures. (could a complex partial seizure still be a pseudo or psychogenic seizure?) Again, we are suspicious that mom could have altered the letter because she is embarassed or hiding something. Mom has refused to allow our school counselor to help him.

Presumably if a pediatric neurologist has diagnosed complex partial seizures, they have documented such on EEG to confirm the diagnosis. That said, it IS possible for someone with a seizure disorder to also have pseudo-seizures.

Standard practice is typically to call EMS for seizures lasting longer than 5 min but there are some cases where it may be appropriate to wait 10 min, just as there are some cases where you would call EMS immediately. Complex partial seizures typically do not require abortive medication and don't typically compromise the patient's respiratory status the way a generalized tonic clonic seizure might. If this is truly the MD's plan, I wouldn't have a problem executing it but I would want to confirm that it IS the MD's plan and not the mom's.

Specializes in Community and Public Health, Addictions Nursing.

You say that mom won't allow you to speak with her son's neurologist, but I think if this were me I'd disregard that a little. You are taking orders from this doctor about the boy's seizure plan. If you have a question about the orders, as the nurse, I'd think you should have the right to clarify the orders no matter what. If I had questions about the orders in place and nobody in this doctor's office would speak with me about it, then I'd be refusing to give any medication, etc. and would be calling 911 when that seizure hits 5 minutes. It's not like you want to have a gab fest with the doctor's office all about this strange mom and her son- you simply want to double check the pt's diagnosis and plan with someone in the office directly. And you should have that right to protect your license and this boy's health.

Specializes in school nursing, ortho, trauma.

in cases where i think that the parent may have altered something from the doctor, permission to speak to the md or not, I have contacted them, spoken to the reception staff to ask if I could fax over a document and simply get a fax back confirmation that this was indeed the original order or plan as written by the doctor. You are not asking for any new information, you are just looking to get confirmation that the order wasn't altered in any was, especially if you have suspicions that something was altered.

I do agree that 10 minutes does seem like a long time, but in hearing that the seizures are partial, it is not completely out of touch with reality. It is in your best interest to verify this and document the sweet bejeezus out of this though once clarified.

Specializes in Pediatrics, Public Health, Travel.

OldDude said it well. I teach a seizure management classes for school nurses and the EFVA.org site has a great youtube video for school nurses. Also be aware that this student may have PNES, a non-epileptic, psychogenic seizure. These seizures are non-life threatening, do not require diastat (infact that may make it worse), can last for longer periods of time (even hours), and look like a tonic clonic seizure. I agree you need to be able to communicate with the doctor or at least have better communication from the parent. I would go with district protocols for seizure management until you have better written orders. Also- does this child have a 504 plan or an IEP- if not maybe something to be considered. Good Luck!

What we have done is told parents we know there is a plan in place, but I used my nursing judgement and felt your son's safety was at risk if we waited 10 minutes. Talk to your administrator and document every time you talk to this parent or have a witness to every conversation. It is very unfortunate that this happens.

Specializes in BNAT instructor, ICU, Hospice,triage.

The student had an EEG, was at the hospital for 2 days, and found to be having psychogenic seizures. All meds have been discontinued and therapy has started. He did tons better the last 2 days. Just having one seizure per day but he is still very much a handfull for his teacher. God bless her sweet kind soul!!! Its a full time job to care for him alone. He has constant complaints and anxiety.

I agree with following the standard for seizures. If Mom doesn't want EMS, she can come to school and take her child home. If something happens, the nurse will be the first person answering questions as to what went wrong. Also speak to the supervising medical doctor in your district, if you have one, so they can speak to the doctor MD to MD.

My son has seizures and I was told to call after 5 minutes.

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