Seizing patient

[Jo82]

Hi

Jst wondering if anyone could advise me on this,

Yesterday I had a young female have a seizure on my ward, I responded by putting 100% o2 on via mask, it lasted about 15 seconds, then it happened again, this time I gave her 2mg of lorapam, in all it happened 13 times, and in total she got 8mg of lorazapam and 5 mgs of midazolam, on the advice of the doctors to keep giving her the meds every time she seized. She also got 1g of phenytonin iv in 1000mls of nacl. Im jus wondering is this an appropriate thing to do. Surely if I jus kept giving her those meds it could overdose her. Im wracked with guilt today and im not back to work until Monday so I wont know how things went after I went off shift.

The more I think about it now they could have been pseudoseizures, as the last few at the end she was crying during them. Which makes me feel even worse as I could have been giving her the meds unnecessarily. But the initial ones seemed very real.

It was my first seizure and im fairly newly qualified so your advice would be appreciated.

Thanks

J

[LoveMyBugs, BSN, CNA, RN]

Ativan and Diazepam are the standard rescue drugs and a loading dose for phenytoin for longer coverage is standard.

Are you worried that you overdosed her? Did you update the MD? Monitor her vitals? Pts don't have to be uncounsous when they seize and can cry because having and whittnessing a seizure can be scary, especially if it was your 1st one.

Did your pt have a history?

In addition to giving rescue meds turn the pt on their side, protect them from hurting themselves is about all you can do, and time the seizure which is what it sounds like you did

[Jo82]

Thanks for the reply, guess I was just looking for some reassurance as it was my first one, she did have a hx of seizures that was her reason for admission, she had nothing diagnosed yet but was being investigated for temporal lobe epilepsy. She alse had a hx of psychosis.

I did monitor her vitals each time, and kept the doctor informed. Also put her on her side. I guess my question is can u keep on giving loraz or midazolam for each and every seizure or is their a limit I couldnt find much info in Drugs manual. Then her iv access blocked and docs wouldnt come and resite ss they were extremely busy with it being new years day there was only on call working. A very stressful day all round and I jus needed to vent.

[LoveMyBugs, BSN, CNA, RN]

There is a limit, but I work with peds so it is all based on their weight. Look at your drug guide or call your friendly pharmacist, for max dosages.

Also consider time, peak and duration, that is why MDs need to write for parameters.

I had a pt one time seize for 45 min in a LTC, gave her 3 rounds on diastat then we went to fosphentoin IM gave 2 rounds of that before we got her sent off to the ER. We had her doctor on the phone giving us verbal orders for the 3 round of diastat and the the fos. When she got to the ED and her levels where drawn she had critical high of fosphentoin in her system and continued to seize...this was a rare case.

Get familiar with the different types of seizures, and rescue protocols

[Jo82]

Thanks for the advice, its a another learning curve, I will study up on the subject and find out what our local protocol is

[tokmom, BSN, RN]

Everyone has a limit and responds differently to the meds. Having suction and oxygen nearby is always a good idea and monitoring the vitals as best as you can. I would have pushed the drugs like the docs ordered, just a tiny bit slower because she probably is naive if this is her initial diagnosis. We have actually intubated pts seizing long periods of time just to stop the episode.

My husband has seizures and he can also talk during them, and has never lost bowel or bladder function. Everyone is different.

[Nibbles1]

I've seen some nasty seizures. I have witnessed children with broken arms and chipped teeth because of them. I had an order to give a large dose of diazepam before. I remember thinking, "omgosh, this is going to kill them." Nope they woke up several hours later. All pink and perky.