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on-call:approach-to-im-on-call-emergencies-issues [on May 19, 2019] |
on-call:approach-to-im-on-call-emergencies-issues [on February 19, 2023] psychdb [Seizures] |
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| ====== Approach to On-Call Internal Medicine Emergencies and Issues ====== | ====== Approach to On-Call Internal Medicine Emergencies and Issues ====== | ||
| + | {{INLINETOC}} | ||
| ===== Primer ===== | ===== Primer ===== | ||
| **Common Internal Medicine** issues and emergencies for psychiatric patients may occur. It is important for any psychiatrist to have a good approach to these issues and to direct the right work up and medical care. | **Common Internal Medicine** issues and emergencies for psychiatric patients may occur. It is important for any psychiatrist to have a good approach to these issues and to direct the right work up and medical care. | ||
| ===== Vital Signs ===== | ===== Vital Signs ===== | ||
| - | Never forget the vital signs because they are //vital//. These are some indications that a patient is seriously ill and need more support: | + | Never forget the vital signs because they are //vital//. Always remember the A-B-C-Ds: |
| - | * **Airway**: Threatened, stridor, excessive secretions | + | * **Airway**: Threatened airway, stridor, excessive secretions |
| * **Breathing**: RR ≤ 8 or ≥ 30, distressed breathing, saturations < 90% on ≥50% 02 or 6L/min | * **Breathing**: RR ≤ 8 or ≥ 30, distressed breathing, saturations < 90% on ≥50% 02 or 6L/min | ||
| * **Circulation**: Systolic blood pressure ≤ 90 mmHg or ≥ 200 mmHg or decrease >40 mmHg, HR ≤40 or ≥130 | * **Circulation**: Systolic blood pressure ≤ 90 mmHg or ≥ 200 mmHg or decrease >40 mmHg, HR ≤40 or ≥130 | ||
| * **Disability**: Decreased level of consciousness (GCS decrease ≥2 points) | * **Disability**: Decreased level of consciousness (GCS decrease ≥2 points) | ||
| * **Other**: Urine output ≤100 cc over 4 hours (except dialysis patients) | * **Other**: Urine output ≤100 cc over 4 hours (except dialysis patients) | ||
| - | * Any other serious concern for the patient | ||
| ===== Chest Pain ===== | ===== Chest Pain ===== | ||
| <WRAP group> | <WRAP group> | ||
| <WRAP half column> | <WRAP half column> | ||
| - | == Differential Diagnosis == | + | == Initial == |
| - | * Differential diagnosis should include non-cardiac causes! The top two serious causes to rule out on a medical ward are pulmonary embolism and MI, while the most common causes of chest are costochondritis (musculoskeletal chest pain) and GERD. | + | |
| - | * Think cardiac, thorax (not heart), chest wall, GI | + | |
| - | * This includes myocardial infarction, pulmonary embolism, aortic dissection, pericarditis, tension pneumothorax, esophageal rupture | + | |
| - | * These are important things to not miss! A severe presentation of any of the above (except for a pulmonary embolism) will also come with other signs and symptoms (the patient will look very unwell or also have other abnormalities on their vital signs) | + | |
| - | </WRAP> | + | |
| - | <WRAP half column> | + | |
| * Assess the patient | * Assess the patient | ||
| * Monitor the vitals closely over time | * Monitor the vitals closely over time | ||
| Line 28: | Line 22: | ||
| * Chest X-Ray should also be considered if relevant | * Chest X-Ray should also be considered if relevant | ||
| * Can also empirically order Tylenol, morphine to temporize pain (if there are no contraindications to the above) | * Can also empirically order Tylenol, morphine to temporize pain (if there are no contraindications to the above) | ||
| + | |||
| == Physical Exam == | == Physical Exam == | ||
| * Inspect, palpate, auscultate | * Inspect, palpate, auscultate | ||
| Line 33: | Line 28: | ||
| * What is the quality of the pain? (Sharp and stabbing?) | * What is the quality of the pain? (Sharp and stabbing?) | ||
| + | </WRAP> | ||
| + | <WRAP half column> | ||
| + | == Differential Diagnosis == | ||
| + | * Differential diagnosis should include non-cardiac causes! The top two serious causes to rule out on a medical ward are pulmonary embolism and MI, while the most common causes of chest are costochondritis (musculoskeletal chest pain) and GERD. | ||
| + | * Think cardiac, thorax (not heart), chest wall, GI | ||
| + | * This includes myocardial infarction, pulmonary embolism, aortic dissection, pericarditis, tension pneumothorax, esophageal rupture | ||
| + | * These are important things to not miss! A severe presentation of any of the above (except for a pulmonary embolism) will also come with other signs and symptoms (the patient will look very unwell or also have other abnormalities on their vital signs) | ||
| </WRAP> | </WRAP> | ||
| </WRAP> | </WRAP> | ||
| Line 43: | Line 45: | ||
| * **Troponin** | * **Troponin** | ||
| * **Troponins are NOT a substitute for clinical suspicion of an MI**. | * **Troponins are NOT a substitute for clinical suspicion of an MI**. | ||
| - | * Interpretation of troponin levels can be difficult. Troponins have high sensitivity (e.g. - good at ruling out an MI), but low specificity. A negative troponin and a stable troponin lets you rule out MI, but a positive one does not let you rule it in. Troponin elevations can either be “false positives” (chronic kidney disease, intracranial process, sympathetic stimulation), poor prognostic markers of non-ischemic disease (e.g. pulmonary embolism), or true indicators of ischemia (demand ischemia, NSTEMI, STEMI) | + | * Interpretation of troponin levels can be difficult. Troponins have high sensitivity (i.e. - good at ruling out an MI), but low specificity. A negative troponin and a stable troponin lets you rule out MI, but a positive one does not let you rule it in. Troponin elevations can either be “false positives” (chronic kidney disease, intracranial process, sympathetic stimulation), poor prognostic markers of non-ischemic disease (e.g. pulmonary embolism), or true indicators of ischemia (demand ischemia, NSTEMI, STEMI) |
| * Can order a serial CK and troponin in 4 hours to see if it trends upwards | * Can order a serial CK and troponin in 4 hours to see if it trends upwards | ||
| * A normal CK but elevated troponin is less likely to be an NSTEMI or STEMI | * A normal CK but elevated troponin is less likely to be an NSTEMI or STEMI | ||
| Line 79: | Line 81: | ||
| </WRAP> | </WRAP> | ||
| </WRAP> | </WRAP> | ||
| + | |||
| + | <imgcaption image1|>{{ :on-call:schematic_of_atrial_repol_wave_from_my_book.png?600 |The ECG In Acute MI, Stephen W. Smith, MD}} | ||
| + | </imgcaption> | ||
| + | |||
| + | ===== Tachycardia ===== | ||
| + | ==== Stable or Unstable ==== | ||
| + | * First question is always "is the patient stable?" | ||
| + | * If unstable: | ||
| + | * Call a ''CODE BLUE'' or activate Rapid Response | ||
| + | * If stable: | ||
| + | * What is the rhythm of their pulse? | ||
| + | * Get an ECG | ||
| + | |||
| + | <callout type="info" title="ECG Strip Reading" icon="true"> | ||
| + | Is the QRS narrow or wide? | ||
| + | * If wide: it is VT until proven otherwise | ||
| + | * If narrow: it is either sinus tachycardia vs SVT | ||
| + | * Sinus tachycardia | ||
| + | * ECG shows: P before every QRS, QRS after every P, P is upright in leads I, II, PR is fixed | ||
| + | * Differential diagnosis: Pain, agitation, withdrawal, sepsis, volume depletion, PE, heart failure, pain, agitation, withdrawal, sepsis, volume depletion, heart failure | ||
| + | * SVT | ||
| + | * Most commonly will be due to Atrial fibrillation (AF) or Atrial flutter | ||
| + | * How fast is the HR? | ||
| + | * Are they on rate control agents already? | ||
| + | * Again, if unstable, call for help! | ||
| + | * Think of why this is happening! Treat underlying cause first, rather than just increasing meds | ||
| + | </callout> | ||
| + | |||
| + | == Atrial Fibrillation Management == | ||
| + | A HR <110 is acceptable. Don’t need to be aggressive unless there are ischemic symptoms (angina, troponin bump, ECG changes, etc). | ||
| ===== Hypotension/Hypertension ===== | ===== Hypotension/Hypertension ===== | ||
| When managing issues around blood pressure, there are only four possible scenarios: | When managing issues around blood pressure, there are only four possible scenarios: | ||
| - | <WRAP col2> | ||
| - **Hypotensive Bad**: BP is //low// and the patient is dying! | - **Hypotensive Bad**: BP is //low// and the patient is dying! | ||
| - **Hypotensive Fine**: BP is //low//, patient is fine, should we hold antihypertensives? | - **Hypotensive Fine**: BP is //low//, patient is fine, should we hold antihypertensives? | ||
| - **Hypertensive Fine**: BP is //high//, patient is fine, do we treat with antihypertensives? | - **Hypertensive Fine**: BP is //high//, patient is fine, do we treat with antihypertensives? | ||
| - **Hypertensive Bad**: BP is //high//, and patient is having associated symptoms | - **Hypertensive Bad**: BP is //high//, and patient is having associated symptoms | ||
| - | </WRAP> | + | ==== Hypotension ==== |
| - | == Hypotension == | + | |
| <WRAP group> | <WRAP group> | ||
| <WRAP half column> | <WRAP half column> | ||
| Line 94: | Line 124: | ||
| <panel type="info" title="Stopping Antihypertensives" subtitle="" no-body="true" footer=""> | <panel type="info" title="Stopping Antihypertensives" subtitle="" no-body="true" footer=""> | ||
| - | ^ Easy to Stop | Calcium channel blockers (amlodipine), ACE inhibitors (-prils), ARBS (-sartans), and hydrochlorothiazides | | + | ^ Easy to Stop | • Calcium channel blockers (amlodipine) \\ • ACE inhibitors (-prils) \\ • ARBS (-sartans) \\ • Hydrochlorothiazides | |
| - | ^ Harder to Stop | Beta blockers (generally do not cause that much hypotension and may be important in avoiding tachyarrythmias such as atrial fibrillation which may worsen heart failure), furosemide (may be needed in ongoing treatment of heart failure) | | + | ^ Harder to Stop | • Beta blockers (generally do not cause that much hypotension and may be important in avoiding tachyarrythmias such as atrial fibrillation which may worsen heart failure)\\ • Furosemide (may be needed in ongoing treatment of heart failure) | |
| </panel> | </panel> | ||
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| * Management | * Management | ||
| * If due to sepsis, give more IV fluids and repeat lactate | * If due to sepsis, give more IV fluids and repeat lactate | ||
| + | * If due to dehydration, give IV fluids (consider 0.9% NS to avoid inducing hyponatremia)[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4096820/|Bhave, G., & Neilson, E. G. (2011). Volume depletion versus dehydration: how understanding the difference can guide therapy. American journal of kidney diseases, 58(2), 302-309.]])] | ||
| * If due to heart failure (especially if patient is hypoxic from heart failure), do not give more IV fluids | * If due to heart failure (especially if patient is hypoxic from heart failure), do not give more IV fluids | ||
| </callout> | </callout> | ||
| Line 113: | Line 144: | ||
| </WRAP> | </WRAP> | ||
| - | == Hypertension == | + | ==== Hypertension ==== |
| <WRAP group> | <WRAP group> | ||
| <WRAP half column> | <WRAP half column> | ||
| Line 148: | Line 179: | ||
| ===== Glucose Abnormalities ===== | ===== Glucose Abnormalities ===== | ||
| - | == Hyperglycemia == | + | ==== Hyperglycemia ==== |
| - | * Hyperglycemia is of little significance acutely UNLESS they are in DKA from it, and that usually requires at least a few days’ worth of insulin deficiency before it happens. | + | <alert type="info" icon="fa fa-book fa-lg fa-fw"> |
| - | * The key here is that in DKA the patient will be acidotic (low bicarb, high AG). In the context of positive ketones and known diabetes -- this is DKA regardless of the glucose value (euglycemic DKA is possible and much higher incidence with SGLT2 inhibitors) | + | See also: |
| - | * You will likely be paged for blood glucose >20 because that’s how the default sliding scale orders are written | + | * ** {{:on-call:insulinstarttool_e_print.pdf |Guide to Starting and Adjusting Insulin for Type 2 Diabetes}}** |
| - | * Rule of thumb to fix hyperglycemia | + | * **[[https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-endocrine-electrolytes/hyperglycemia|Hyperglycemia: Society for Academic Emergency Medicine]]** |
| - | * Easy version: just give the max dose according to the sliding scale, or just give 2 units of insulin and ride it out | + | </alert> |
| + | <WRAP group> | ||
| + | <WRAP half column> | ||
| + | * Hyperglycemia is usually of little significance acutely **unless** the patient is in diabetic ketoacidosis (DKA) or in a hyperosmolar hyperglycemic state (HHS) from it, and that usually requires at least a few day's worth of insulin deficiency before this happens. | ||
| + | * Diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) are the most serious, acute metabolic complications of diabetes, but other differentials include dietary indiscretion and new onset or uncontrolled diabetes | ||
| + | * **DKA** is a state of absolute insulin deficiency, hyperglycemia, anion gap acidosis, and dehydration. It classically occurs in younger patients (<65 years) with Type 1 diabetes and usually evolves rapidly over 24 hours. The most common causes are infections, disruption of insulin therapy, or as the presentation of new onset diabetes. | ||
| + | * **HHS** is a state of hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis. It is typically seen in Type 2 diabetics, and has a higher mortality rate compared to DKA, and occurs in older patients. It most commonly occurs in older patients (>65 years old) with infections and/or poorly controlled Type 2 diabetes and evolves over several days. | ||
| + | * Both DKA and HHS originate from a //reduction// in insulin and an //increase// in counter-regulatory stress hormones. | ||
| + | * The key here is that in DKA the patient will be acidotic (low bicarb, high anion gap). In the context of positive ketones and known diabetes -- this is DKA regardless of the glucose value (euglycemic DKA is possible and has a much higher incidence with SGLT2 inhibitors) | ||
| + | </WRAP> | ||
| + | <WRAP half column> | ||
| + | <callout icon="fa fa-lightbulb-o" type="success" title="Mnemonic"> | ||
| + | The 6 ''**I's**'' can be used to remember the I’s of DKA and HHS: | ||
| + | * ''**I**'' - **Insulin deficiency** (New onset T1DM, failure to take enough insulin) | ||
| + | * ''**I**'' - **Infection** is the most common precipitating factor (Pneumonia, UTI) | ||
| + | * ''**I**'' - **Ischemia** or **Infarction** (MI, CVA, Acute Mesenteric Ischemia) | ||
| + | * ''**I**'' - **Inflammation** (Pancreatitis, Cholecystitis) | ||
| + | * ''**I**'' - **Intoxication** (Alcohol, Drugs) | ||
| + | * ''**I**'' - **Iatrogenesis** (Glucocorticoids, Thiazides) | ||
| + | </callout> | ||
| + | </WRAP> | ||
| + | </WRAP> | ||
| + | |||
| + | * **Correcting Hyperglycemia** | ||
| + | * You will likely be paged for blood glucose >20 because that’s how the default sliding scale orders are written | ||
| + | * **Easy version**: just give the maximum dose according to the sliding scale, or just give 2 units of insulin and ride it out | ||
| + | * Before administration of insulin, always ask: | ||
| + | * When was the last meal or snacks? | ||
| + | * What are the vitals? | ||
| + | * Look at the blood sugar trends over past week and baseline (if available) | ||
| + | * Remember that treating hyperglycemia can cause potassium shifts and may result in ECG abnormalities | ||
| + | * Most individuals with hyperglycemia will in fact be asymptomatic | ||
| + | * The classic symptoms that you should ask about include: | ||
| + | * Polyuria | ||
| + | * Polydipsia | ||
| + | * Polyphagia | ||
| + | * Weight loss | ||
| + | * Ask about symptoms of DKA: | ||
| + | * Abdominal pain | ||
| + | * Hyperpneic respirations (fast and deep Kussmaul respirations) | ||
| + | * Hypotension | ||
| + | * Ketotic breath (fruity odor in DKA) | ||
| + | * Marked tachycardia (in patients with marked acidemia or severe hyperglycemia, extracellular potassium shifts may result in ECG manifestations of hyperkalemia despite total body losses) | ||
| + | * Neurologic symptoms (seizures, focal weakness, lethargy, coma, death) | ||
| + | |||
| + | * **General Blood Sugar Targets** | ||
| + | * Pre-prandial goal: 5-8 | ||
| + | * Random blood glucose: <10 | ||
| + | * Start correcting if the BG > 10 | ||
| + | * **Wait about 2 hours after eating or insulin administration to check the blood glucose again** | ||
| - | == Hypoglycemia == | + | ==== Hypoglycemia ==== |
| - | * Hypoglycemia is much more concerning than hyperglycemia (risk of seizures, decreased LOC, cardiac events) | + | * Hypoglycemia is much more concerning than hyperglycemia because there is a risk for seizures, decreased LOC, and cardiac events |
| * Immediate treatment is to ask the nurse to give juice/sugars | * Immediate treatment is to ask the nurse to give juice/sugars | ||
| * Otherwise, you need to know how to push D50W (also for shifting hyperkalemia) to resolve this as it doesn’t come with a fluid load like running D5W or D10W does and it works the fastest | * Otherwise, you need to know how to push D50W (also for shifting hyperkalemia) to resolve this as it doesn’t come with a fluid load like running D5W or D10W does and it works the fastest | ||
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| ===== Electrolyte Abnormalities ===== | ===== Electrolyte Abnormalities ===== | ||
| <callout type="success">{{fa>arrow-circle-right?color=green}} See also main articles on: **[[cl:hypocalcemia|]], [[cl:hypercalcemia-hyperparathyroidism|]], [[cl:hypokalemia|]], [[cl:hypomagnesemia|]], and [[cl:hyponatremia|]]**</callout> | <callout type="success">{{fa>arrow-circle-right?color=green}} See also main articles on: **[[cl:hypocalcemia|]], [[cl:hypercalcemia-hyperparathyroidism|]], [[cl:hypokalemia|]], [[cl:hypomagnesemia|]], and [[cl:hyponatremia|]]**</callout> | ||
| - | == Potassium (Hyperkalemia/Hypokalemia) == | + | ==== Potassium (Hyperkalemia/Hypokalemia) ==== |
| <WRAP group> | <WRAP group> | ||
| <WRAP half column> | <WRAP half column> | ||
| Line 205: | Line 285: | ||
| </WRAP> | </WRAP> | ||
| - | == Hypomagnesemia == | + | ==== Hypomagnesemia ==== |
| * If critically low (<0.5): order an ECG to assess QT segment | * If critically low (<0.5): order an ECG to assess QT segment | ||
| * Treat with MgSO4 2-4g IV in 200-400cc D5W over 2-4hours (all respectively). The nurses will often know the protocol and ordering MgSO4 2g IV should be sufficient | * Treat with MgSO4 2-4g IV in 200-400cc D5W over 2-4hours (all respectively). The nurses will often know the protocol and ordering MgSO4 2g IV should be sufficient | ||
| - | == Hypophosphatemia == | + | ==== Hypophosphatemia ==== |
| * If critically low: check K, then replace IV with KPhos 15mmol in 500cc D5W if K < 3.5, OR use NaPhos 15mmol in 500cc D5W if K > 3.5 | * If critically low: check K, then replace IV with KPhos 15mmol in 500cc D5W if K < 3.5, OR use NaPhos 15mmol in 500cc D5W if K > 3.5 | ||
| * If non critical: replace with phosphate novartis 500mg PO | * If non critical: replace with phosphate novartis 500mg PO | ||
| <WRAP group> | <WRAP group> | ||
| - | == Sodium (Hyponatremia/Hypernatremia) == | + | ==== Sodium (Hyponatremia/Hypernatremia) ==== |
| <WRAP half column> | <WRAP half column> | ||
| **Hyponatremia** | **Hyponatremia** | ||
| Line 245: | Line 325: | ||
| * ABGs are useless in an acute respiratory emergency. If the patient is already desaturating or having low normal saturation on high FiO2, then they are hypoxic. Doing an ABG will NOT help you in this acute situation. | * ABGs are useless in an acute respiratory emergency. If the patient is already desaturating or having low normal saturation on high FiO2, then they are hypoxic. Doing an ABG will NOT help you in this acute situation. | ||
| * You may send a VBG if a RN is taking blood work, and this would be to rule out a hypercapnic component to the respiratory failure | * You may send a VBG if a RN is taking blood work, and this would be to rule out a hypercapnic component to the respiratory failure | ||
| - | ===== Tachycardia ===== | ||
| - | <WRAP group> | ||
| - | <WRAP half column> | ||
| - | == Stable or Unstable == | ||
| - | * First question is always "is the patient stable?" | ||
| - | * If unstable | ||
| - | * Call a ''CODE BLUE'' or activate Rapid Response | ||
| - | * If stable: | ||
| - | * What is the rhythm of their pulse? | ||
| - | * Get an ECG | ||
| - | </WRAP> | ||
| - | <WRAP half column> | ||
| - | <callout type="info" title="ECG Strip Reading" icon="true"> | ||
| - | Is the QRS narrow or wide? | ||
| - | * If wide: it is VT until proven otherwise | ||
| - | * If narrow: it is either sinus tachycardia vs SVT | ||
| - | * Sinus tachycardia | ||
| - | * ECG shows: P before every QRS, QRS after every P, P is upright in leads I, II, PR is fixed | ||
| - | * Differential diagnosis: Pain, agitation, withdrawal, sepsis, volume depletion, PE, heart failure, pain, agitation, withdrawal, sepsis, volume depletion, heart failure | ||
| - | * SVT | ||
| - | * Most commonly will be due to Atrial fibrillation (AF) or Atrial flutter | ||
| - | * How fast is the HR? | ||
| - | * Are they on rate control agents already? | ||
| - | * Again, if unstable, call for help! | ||
| - | * Think of why this is happening! Treat underlying cause first, rather than just increasing meds | ||
| - | </callout> | ||
| - | </WRAP> | ||
| - | </WRAP> | ||
| - | == Atrial Fibrillation Management == | ||
| - | A HR <110 is acceptable. Don’t need to be aggressive unless there are ischemic symptoms (angina, troponin bump, ECG changes, etc). | ||
| ===== Altered Level of Consciousness ====== | ===== Altered Level of Consciousness ====== | ||
| <WRAP group> | <WRAP group> | ||
| <WRAP half column> | <WRAP half column> | ||
| - | <callout type="success">{{fa>arrow-circle-right?color=green}} See main article: **[[neurology/approaches/1-neuro-emergencies#altered-level-of-consciousness|Approach to Neurologic Emergencies: Altered Level of Consciousness]]**</callout> | + | <callout type="success">{{fa>arrow-circle-right?color=green}} See main article: **[[neurology:1-approach-neuro-emergencies#altered-level-of-consciousness|Approach to Neurologic Emergencies: Altered Level of Consciousness]]**</callout> |
| </WRAP> | </WRAP> | ||
| Line 313: | Line 363: | ||
| ===== Constipation ===== | ===== Constipation ===== | ||
| - | Assess the timeline of symptoms. It is only urgent if there is impaction with large fecaloma (bacterial translocation, mucosal ischemia) | + | * Assess the timeline of symptoms |
| + | * Constipation is only an emergency if there is impaction with large fecaloma (bacterial translocation, mucosal ischemia) | ||
| == Treatment == | == Treatment == | ||
| - | Lactulose (30cc PO can give BID) or PEG 3350 (17g PO) are most effective. Never use docusate sodium (//Colace//), it is not an effective drug! | + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> |
| + | See main article: **[[meds:antipsychotics:constipation|]]** | ||
| + | </alert> | ||
| + | * Lactulose (30cc PO can give BID) or PEG 3350 (17g PO) are most effective. Never use docusate sodium (//Colace//), it is not an effective drug! | ||
| ===== Seizures ===== | ===== Seizures ===== | ||
| - | <callout type="success">{{fa>arrow-circle-right?color=green}} See main article: **[[neurology:approaches:seizures#treatment|Approach to Seizures: Treatment]]**</callout> | + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> |
| + | See main article: **[[neurology:approach-seizures#treatment|Approach to Seizures: Treatment]]** | ||
| + | </alert> | ||
| If you witness a seizure, call for help, as the patient will likely have decreased LOC following the event. It is appropriate to call a code blue (“Medical Emergency”) if you need medications or more support. The first line treatment is with benzodiazepines either IV (preferred or IM). Give lorazepam 2mg, or midazolam 2mg, or diazepam 5mg q2-5minutes PRN until seizures are controlled. If not already on antiepileptics, it is reasonable to load them with dilantin (20mg/kg) to prevent further seizures. | If you witness a seizure, call for help, as the patient will likely have decreased LOC following the event. It is appropriate to call a code blue (“Medical Emergency”) if you need medications or more support. The first line treatment is with benzodiazepines either IV (preferred or IM). Give lorazepam 2mg, or midazolam 2mg, or diazepam 5mg q2-5minutes PRN until seizures are controlled. If not already on antiepileptics, it is reasonable to load them with dilantin (20mg/kg) to prevent further seizures. | ||
| ===== Resources ===== | ===== Resources ===== | ||