Intubation post GM seizure: when ?

Sun May 18 15:38:52 BST 2008

This is silly.  I need to cite references for the effects of gravity on
secretions?

The treatment for a post ictal patient is to turn him on his side, observe
him closely, and expect for him to wake up.  Millions of people grow to old
age with seizure disorders with thanks to this simple advice.  We don't
train families to tube them, because there is ZERO indication for it.

Nobody is going to be faulted over reasonable and prudent care.  Intubation,
on the other hand, is neither a reasonable nor prudent modality in this
context, and any consequences arising there from will carry a stiff civil
penalty and expose the provider as an abject doofus.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ivan Hronek
Sent: Saturday, May 17, 2008 10:33 AM
To: Trauma &amp; Critical Care mailing list
Cc: Anesthideas at yahoogroups.com; ccm-l at ccm-l.org
Subject: Intubation post GM seizure: when ?

Piet, why do you put them in the recovery position ? 
To please the authors of textbooks ?
To prevent aspiration ?
Is the recovery position a sufficient protection from aspiration in a
patient with a full stomach ?
The answer is:no, it is not.
If a "post-ictal" patient after a seizure aspirates under your care, you are
going to be faulted.
Matthias, if the patient can be woken up, it is not coma, it is stupor, or
sleep, then obviously there's no need to intubate as gag reflex will be
present. 
If you cannot wake the patient up within minutes after a seizure, they are
no "sleeping" but they are in a coma. Comatose patients most of the time
have no protective reflexes. That's why we intubate patients with a GCS < 8
- to protect them from aspiration. 
A coma is a coma in the sense there will be no protective laryngeal reflexes
present with risk of aspiration.
The etiology of the coma from that viewpoint is irrelevant. The fact that
everyone around the world considers the "post-ictal" state immune to
aspiration and don't intubate is amazing. It is amazing how thoughtless we
can be.

Ivan Hronek
MD                                                                          
    Nobody cares if you can't dance well. Just get up and dance. Great
dancers are not great because of their technique. They are great because of
their passion. Martha Graham
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----- Original Message ----
From: "Bjorn, Pret" <pbjorn at emh.org>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Saturday, May 17, 2008 5:37:30 AM
Subject: RE: Intubation post GM seizure: when ?

Agreed.  Simple seizures should be placed in a recovery position and
watched.  Bear in mind that they've survived x many years with a seizure
disorder which has hopefully not required repeated intubation.  The post
ictal phase is transient, and as such carries no indication for
intubation.  

Pret Bjorn RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Mathias Kalkum
Sent: Saturday, May 17, 2008 5:56 AM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Intubation post GM seizure: when ?

Ivan,

you are still confusing me. What are we talking about? Are we talking 
about GM seizures after trauma (be it head or whatever)? Are we talking 
about GM seizures after poisoning? Or are we talking about epilepsy?

In the first two entities our treatment has to take into account the 
underlying pathology, in the later we have to simply accept that 
postictal sleep is by no means what you like to call coma. Please do not

make analogies where there are none (or, at least, show us the data!).

Take care!

Mathias
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