Читать книгу Emergency Medical Services - Группа авторов - Страница 399

Continued patient management in the ED is influenced by what occurred in the field. If the patient’s condition does not evolve to an alert state, the degree of unresponsiveness should be continuously monitored as evaluation proceeds along the pattern of primary survey, resuscitation, secondary survey, and definitive care steps. Information from EMS personnel regarding level of alertness in the field is helpful.

Should the need for a definitive airway be established, rapid sequence intubation is performed in the usual manner, and this is a field option for some paramedics and EMS physicians. Concerns for possible increased intracranial pressure, if suspected from history or physical examination, may prompt consideration for lidocaine administration as part of rapid sequence intubation, although this remains controversial. Most induction agents have some anticonvulsant properties and use of benzodiazepines would seem prudent, although data are lacking to support these actions. The use of short‐acting paralytic agents, if necessary, should proceed in the usual manner [53]. There are only rare case reports in medically complex seizure patients of complications from succinylcholine [54]. Longer‐acting neuromuscular blockade should be avoided, however, unless EEG monitoring can be established, because of concerns that seizure activity may be disguised by neuromuscular paralysis.

Somnolent patients should be observed and monitored. The postictal state is not well defined, but the possibility of ongoing subclinical seizure activity, complex medical issues, or trauma should be considered if a seizure patient is not starting to become alert within approximately 30 minutes.