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Sun May 18 15:50:02 BST 2008

Gravity is not JUST a good idea, it's the law.

On Sun, May 18, 2008 at 10:38 AM, Pret Bjorn <p.bjorn at netzero.net> wrote:

> This is silly.  I need to cite references for the effects of gravity on
> secretions?
>
> The treatment for a post ictal patient is to turn him on his side, observe
> him closely, and expect for him to wake up.  Millions of people grow to old
> age with seizure disorders with thanks to this simple advice.  We don't
> train families to tube them, because there is ZERO indication for it.
>
> Nobody is going to be faulted over reasonable and prudent care.
>  Intubation,
> on the other hand, is neither a reasonable nor prudent modality in this
> context, and any consequences arising there from will carry a stiff civil
> penalty and expose the provider as an abject doofus.
>
> Pret
>
>
>
>
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org]
>  On Behalf Of Ivan Hronek
> Sent: Saturday, May 17, 2008 10:33 AM
> To: Trauma &amp; Critical Care mailing list
> Cc: Anesthideas at yahoogroups.com; ccm-l at ccm-l.org
> Subject: Intubation post GM seizure: when ?
>
> Piet, why do you put them in the recovery position ?
> To please the authors of textbooks ?
> To prevent aspiration ?
> Is the recovery position a sufficient protection from aspiration in a
> patient with a full stomach ?
> The answer is:no, it is not.
> If a "post-ictal" patient after a seizure aspirates under your care, you
> are
> going to be faulted.
> Matthias, if the patient can be woken up, it is not coma, it is stupor, or
> sleep, then obviously there's no need to intubate as gag reflex will be
> present.
> If you cannot wake the patient up within minutes after a seizure, they are
> no "sleeping" but they are in a coma. Comatose patients most of the time
> have no protective reflexes. That's why we intubate patients with a GCS < 8
> - to protect them from aspiration.
> A coma is a coma in the sense there will be no protective laryngeal
> reflexes
> present with risk of aspiration.
> The etiology of the coma from that viewpoint is irrelevant. The fact that
> everyone around the world considers the "post-ictal" state immune to
> aspiration and don't intubate is amazing. It is amazing how thoughtless we
> can be.
>
> Ivan Hronek
>
> MD
>     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: "Bjorn, Pret" <pbjorn at emh.org>
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Sent: Saturday, May 17, 2008 5:37:30 AM
> Subject: RE: Intubation post GM seizure: when ?
>
> Agreed.  Simple seizures should be placed in a recovery position and
> watched.  Bear in mind that they've survived x many years with a seizure
> disorder which has hopefully not required repeated intubation.  The post
> ictal phase is transient, and as such carries no indication for
> intubation.
>
> Pret Bjorn RN
> Bangor, ME USA
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Mathias Kalkum
> Sent: Saturday, May 17, 2008 5:56 AM
>  To: Trauma &amp; Critical Care mailing list
> Subject: Re: Intubation post GM seizure: when ?
>
>
> Ivan,
>
> you are still confusing me. What are we talking about? Are we talking
> about GM seizures after trauma (be it head or whatever)? Are we talking
> about GM seizures after poisoning? Or are we talking about epilepsy?
>
> In the first two entities our treatment has to take into account the
> underlying pathology, in the later we have to simply accept that
> postictal sleep is by no means what you like to call coma. Please do not
>
> make analogies where there are none (or, at least, show us the data!).
>
> Take care!
>
> Mathias
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-- 
V/R

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R House Health & Safety
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Intubation post GM seizure: when ?