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Management of prehospital seizure patients by paramedics

机译：医护人员对院前癫痫发作患者的管理

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Background. Seizure patients are frequently encountered in the prehospital environment andhave the potential to need advanced interventions, though the utility of advanced life support (ALS) interventions in many of these patients has not been proven. Objective. Our goals were to assess the management of prehospital seizure patients by paramedics in an urban EMS system with an existing ALS-based prehospital seizure protocol andto assess characteristics andshort-term outcomes that may aid in addressing the utility of specific ALS interventions. Methods. This was a retrospective study of 97 EMS cases with the chief complaint of seizure. Prehospital records were reviewed for patient andevent characteristics, including past seizure history, seizure timing, level of consciousness, on-scene andtransport times, andEMS interventions. Emergency department (ED) records were reviewed for recurrence of seizure activity, ED evaluation, anddisposition. Data were analyzed using descriptive statistics andStudent t-test. Results. Of 87 patients meeting the protocol inclusion criteria for all ALS interventions, 11 (12.6) received cardiac monitoring, 55 (63.2) had intravenous (IV) access attempted, and56 (64.4) had blood glucose determination. Average on-scene time was 5.9 minutes longer if IV access was attempted (p 0.001), though transport times were not significantly different (11.6 versus 11.3 minutes, respectively; p 0.851). Additional seizure activity occurred in the prehospital and/or ED settings in 28 patients (28.9 of all cases), including 17 in the prehospital setting and15 in the ED. Diazepam was administered by EMS for half of the eight (8.2) patients who had seizures lasting more than 1 minute, while the remainder had seizures that were focal or spontaneously resolved. Conclusion. This study showed a lower-than-anticipated level of compliance with an ALS-based prehospital seizure protocol, though patient-specific care appeared appropriate. Prehospital seizure patients have the potential for seizure recurrence andmay benefit from focused ALS interventions, but their heterogeneity makes uniform protocols difficult to develop andfollow.
机译：背景。癫痫发作患者在院前环境中经常遇到，并且有可能需要进行先进的干预，尽管许多患者中的先进生命支持（ALS）干预的效用尚未得到证实。目的。我们的目标是在城市EMS系统中使用现有的基于ALS的院前癫痫发作协议评估医护人员对院前癫痫发作患者的管理，并评估可能有助于解决特定ALS干预措施实用性的特征和短期结果。方法。这是对97例EMS病例的回顾性研究，其中主要是癫痫发作。审查了院前记录的患者和事件特征，包括过去的癫痫病史，癫痫发作时机，意识水平，现场和运输时间以及EMS干预措施。对急诊科（ED）的记录进行了检查，以了解癫痫发作的复发情况，ED评估和处置情况。使用描述性统计和学生t检验对数据进行分析。结果。在符合所有ALS干预方案纳入标准的87例患者中，有11例（12.6）接受了心脏监护，55例（63.2）尝试了静脉（IV）通路，56例（64.4）进行了血糖测定。如果输液时间没有显着差异（分别为11.6分钟和11.3分钟; p = 0.851），则尝试进行IV通路的平均现场时间要长5.9分钟（p 0.001）。 28例患者（28.9例）在院前和/或ED设置中发生了额外的癫痫发作活动，其中在院前设置中有17例发生在ED中。癫痫持续时间超过1分钟的八（8.2）名患者中有一半接受了地西p的EMS治疗，其余患者的病灶为局灶性或自发性发作。结论。这项研究表明，尽管基于患者的特殊护理似乎是适当的，但其对基于ALS的院前癫痫发作方案的依从性水平低于预期水平。院前癫痫发作患者可能会发生癫痫复发，并可能受益于有针对性的ALS干预，但是它们的异质性使得统一的治疗方案难以制定和遵循。

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