The Child in Status Epilepticus Dilemma
The following case is based on a real-life situation, highlighting the difficulties in applying ethical decisions in the prehospital critical care setting. While the case is based from the United Kingdom, it ought to be applicable to similar EMS systems and settings. Kassirer et al. highlight that discussing real-world scenarios helps exemplify reasoning (both good and bad) that the reader ought to relate to within similar and future contexts.1
During the start of a night shift, an ambulance crew consisting of a paramedic and an assistant (EMT-B) are dispatched to a 10-year-old child in status epilepticus (SE). The patient has a known history of frequently experiencing SE, resulting in a specific treatment protocol of phenobarbitone first, followed by diazepam. On arrival, the child is supine with a continuous clonic-like seizure and is on oxygen being ventilated via bag valve mask (BVM), with no airway device by the mother. The duration of the episode is ongoing at 10 minutes, and the phenobarbitone has already been administered. It quickly transpires that the mother is a physician (rheumatologist) and is refusing the administration of diazepam to the child with the belief that this is typically done at hospital by an anaesthetist. Her rationale is due to the child having a high sensitivity to diazepam and history of respiratory arrest. The nearest hospital is 20 minutes away.
Related
Guidelines for Treatment of Prolonged Seizures in Children and AdultsPediatric Sei...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: JEMS Staff Tags: Best Practices Exclusives Patient Care Pediatric Care Seizure Source Type: news
More News: Anesthesia | Anesthesiology | Brain | Cambridge University | Children | Depression | Diazepam | Emergency Medicine | Epilepsy | France Health | Health Management | Learning | Lessons | Medical Ethics | Neurology | Nurses | Nursing | Oxford University | Pediatrics | Respiratory Medicine | Rheumatology | Study | UK Health | United Nations | Universities & Medical Training | Valium