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Reader Feedback: June 2020

Versed and Seizures

I enjoyed Dr. Jeffrey Jarvis’ article “The Pathophysiology of Seizures.” In the article the author talked about giving IM Versed to patients having a generalized seizure since it is faster than waiting to start an IV. I would assume we want faster under the “time is tissue” rule, though there are many other reasons to stop the seizure, such as [that] the patient is not breathing. However, Dr. Jarvis advocates stopping partial seizures but says it is OK to wait to get an IV so a lower Versed dose can be given. Under the same “time is tissue” rule, wouldn’t it be better to stop the seizure faster, even though you must give a higher IM dose, than to wait for the IV?

—J. Cavanaugh O'Leary, NRAEMT

Author’s response: Thanks for your great question. The pathophysiology of generalized seizures is different than for partial seizures. Generalized seizures include all parts of the brain (which is why patients will be unconscious), whereas partial seizures only include one part of the brain. Time to treatment is much more important in a generalized seizure because of the area of cerebral landscape involved. The longer a generalized seizure goes on, the harder it is to stop. This is not necessarily the same with partial seizures.

There is clearly no problem with stopping them earlier, of course. And if you have to make a choice between giving 10 mg Versed IM and waiting a really long time to get an IV to give 5, I’d still go with IM. It’s just that the extra 2–3 minutes to get an IV aren’t likely to be harmful in partial seizures. That time savings turned out to be important in the RAMPART trial of generalized seizures.

—Jeffrey L. Jarvis, MD, MS, EMT-P 

Kudos to the Groundbreaking Female Medics

Listening to these ladies in this video brings back more memories than I can sift through. All throughout my career I have kept quiet because that was the only way you could survive in a man’s world.

I started in Southern Illinois as an EMT and assumed I would never get hired. My first application was thrown in my face and I was ordered out of the ambulance service owner’s office. The comment was, “We don’t hire any damn women. They are a liability.” 

Shortly after we moved to Atlanta, and as luck would have it, the fire department was looking for women to hire. I was the second one to be hired. This was in about 1981–82. I received death threats, sexual harassment to the point of being physically assaulted, and was ordered off of scenes because of my gender. I did not weigh enough to donate blood, yet I was expected to lift the 150-lb. dummy and carry it 100 feet every year. Just as I was to lift and carry large patients without assistance.

I was the first female [in the department] to become pregnant in 1984 and was ordered to quit. I refused. I was in my sixth or seventh month before I won a spot for light duty.

My mother always said, “When they knock you down in life, you get back up fighting.” I will never regret the chaos or those I was privileged to work with who molded me into the medic I became. Some made me competent, and others gave me the determination to prove them wrong. Still here, boys!

Kudos to the women in the film. As the song says, “I am woman, hear me roar.”

—Anne E., online comment

Work All Arrest Patients the Same

[Commenting on an article describing abbreviated resuscitation attempts in COVID cases]

I'll risk exposure to do right by a patient. Doing basically nothing because they might have a virus (with a huge survival rate) is a horrible decision on medical director’s part. And then crews have to deal with knowing they didn’t do everything they could.

[There are] so many worse communicable diseases out there we could catch from patients on any day. [This is] just one more way people are dying indirectly from the virus.

Yes, working for x number of minutes in the field and then calling it is often appropriate. We work 25 minutes without ROSC or a change to a shockable rhythm, then call.

—Rachael D., via Facebook
 

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