I Need Valium STAT
A call comes in that an actively seizuring patient is on its way to your hospital. Your brain starts cataloging what you need to do to be prepared; alert a doctor, ready you clippers, set up a catheter, get endo tubes, grab some valium and Phenobarbital, get flushes, pull your Dextrose from the fridge, and finally make sure the crash kit is nearby. If you have time before the patient presents you quickly read through their medical history. Have they had seizures in the past? Are they being treated with anti-seizure medications? Do they have a history of diabetes, brain tumor, or infectious disease? Have they been known to eat rat poison, plants, their owner’s medications, or other toxins? Are they young or old, big or small? Do they have history of a liver shunt, etc?
Some Common Seizure Presentations
- New puppy that barely weighs more than a small mouse, (likely hypoglycemic, has not been eating great since being diagnosed with kennel cough it picked up at the pet store it was purchased at).
- Cat with history of diabetes, (likely hypoglycemic, owner was unsure if the cat ate this morning but gave the insulin anyway or cat is a transient diabetic).
- Younger dog with history of mild ataxia or “odd” behavior , (could have a liver shunt causing seizures due to the body’s toxins not filtering properly through the liver, or has ingested a toxin).
- Older dog or cat, (probable brain tumor, liver, kidney, or infectious disease).
- A nursing mother, (likely hypocalcaemia).
- Labrador Retriever, (likely idiopathic epilepsy or toxin ingestion; plants, chocolate scented mulch, rat poison, last year’s Halloween candy, grandma’s pill box with a month’s worth of medication in it, or 10 packs of xylitol infused chewing gum).
- A seizuring patient that presents in the middle of summer with a record heat index, (likely hyperthermia so severe it is causing seizure activity).
- Any patient that may have suffered head trauma (ran into a tree, HBC, or unknown origin).
What To Do When Your Patient Arrives
- Be careful! Many times a patient in an active seizure and especially just following or starting to come out of a seizure can exhibit some wildly aggressive behavior due to extreme disorientation caused by the episode.
- Get your doctor to assess the patient as quickly as possible especially in an actively seizuring patient.
- Gain I.V. access. Working on a seizuring patient can be very similar to trying to hold down a bucking bronco, but you need to get that catheter in. The less strain on the body and brain, the better for your patient.
- Once your patient has been stabilized you need to place them in an area where if they seize again they can be seen and not hurt themselves during any new episodes.
- If you can’t visualize your seizure watch patient at all times, you need to move to an area where you can.
- In our “Quick Tips” article we suggest tying a jingle bell to the patient’s foot, so you can also hearthe patient starting to seize.
- Proper cage environment. Pad that cage! The sound of a furry little or big head slamming into a steel cage wall or door is awful, so make certain the cage is nicely padded while insuring a clear view of the patient.
- Keep anti-seizure medication doses posted right on the cage of the patient and keep the Valium at the ready. If your clinic does not allow controlled drugs to be just hanging around, see if you can ask the pharmacy technician to hold some pre-measured doses specifically for that patient.
The goal with these patients is to determine the cause of the seizure activity and hopefully resolve the issue. In such cases as hypoglycemia, heat stroke, and hypocalcaemia, it is usually easier to find a resolution. In cases such as a possible brain tumor, exposure to toxins, infectious disease, liver/kidney failure, or a HBC the solution will probably not come so easy. So your job as the awesome technician that you are is to keep these patients quiet, comfortable, and seizure-free, with as little stimulation around them as possible; lower lights if it’s an option, keep noisy patients or chatty staff away from your patient’s general area, etc. All this will give your doctors the much needed time to come up with a diagnosis or decide on a plan “B”.