Intubation post GM seizure: when ?

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Liebe Mathias,
are you saying that the "post-ictal" state is merely sleep ? Are you sure ? 
Have you tried to wake up a patient who is post-ictal right after a seizure ?
You will not be able to wake them up.
"Sleep" is a nice replacement word when you should be really using a hard diagnosis: coma. 
What happens in a coma ? - Protective reflexes are lost, just like you are saying. 
What happens when protective reflexes are lost ? Aspiration. 
What happens after aspiration ? Trouble with a high percentage of death (lazy - it is a hefty percentage). 
Is that how we whould be taking care of our "post-ictal" post-seizure patients ? 
Leaving them "asleep" with an unprotected airway ?

 Ivan Hronek MD                                                                              
SFMC, Los Angeles, CA                                                
http://health.groups.yahoo.com/group/Anesthideas/                           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: Mathias Kalkum <listen at doc-kalkum.de>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Thursday, May 15, 2008 12:33:30 AM
Subject: Re: Intubation post GM seizure: when ?

Ivan,

it is not a matter of consciousness or not, it is a matter of protective 
reflexes. The question of intubation comes into matter once you have 
started to compromise the latter with your drugs. Thus refrain from the 
reflex of giving meds to a patient whose seizures are finished and who 
is merely sleeping (ah, sorry, read: is in a postictal state).

Cheers!

Mathias
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