Intubation post GM seizure: when ?

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Dear Ivan,
> Liebe Mathias,
> are you saying that the "post-ictal" state is merely sleep ? Are you sure ?

Nein, mein Freund, I am saying that protective reflexes are still 
working once the seizure is over.

> 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.
>   

I am working as an emergency physician in the field for almost 20 years 
now. One of my daughters has been suffering from GM seizures. Yes, I do 
have seen such patients.
> "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 ?

As I have said, your are mixing up things / making wrong analogies. 
Intubation has its place in patients filled up with benzo's, thiopental, 
barbiturates and the like because that is when they loose their 
protective reflexes. And - at least in my reading - that is what Marc 
said as well.

Take care!

Mathias

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