The Role of Tourniquet Placement in Management of a Patient With Status Epilepticus
| Autor: | Patrick Loeffler, Daniel McCollum, Rushay Amarath-Madav |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Sedation
medicine.medical_treatment Status epilepticus Fentanyl 03 medical and health sciences 0302 clinical medicine Status Epilepticus Seizures medicine Intubation Humans Propofol Aged Tourniquet Neuromuscular Blockade business.industry 030208 emergency & critical care medicine Emergency department Tourniquets Anesthesia Emergency Medicine Female medicine.symptom business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | The Journal of emergency medicine. 60(5) |
| ISSN: | 0736-4679 |
| Popis: | Background The global burden of seizure disorders is apparent and necessitates the effective management of patients with status epilepticus (SE). The goal of management is universally accepted as the prompt mitigation of seizure activity with appropriate supportive care. During management, patients may require intubation. In the process of endotracheal tube placement, patients are administered neuromuscular blockers and general anesthesia. Paralytic activity on the neuromuscular junction hinders the emergency physician's ability to effectively observe seizure activity. Moreover, little can be discerned about patient sedation levels for titration. Effective tourniquet placement may be used to separate a region of the body from general circulation, rendering distal tissues unaffected by neuromuscular blockade. Case Report A 73-year-old white woman presented to the emergency department with a stroke, and her condition generalized into diffuse tonic–clonic seizures. Concern for airway integrity warranted intubation with appropriate induction of paralysis and sedation. A tourniquet was placed proximal to the right knee and tightened until a dorsalis pedis pulse was no longer palpable. Computed tomography and computed tomography angiography of the head revealed no cerebrovascular event. After imaging, purposeful movements were noted in the right lower extremity distal to the tourniquet despite the initiation of standard dose post-intubation sedation with fentanyl (0.5 μg/kg/h) and propofol (20 μg/kg/min). No tonic–clonic activity was observed. With necessary up-titration, movements ceased. Why Should an Emergency Physician Be Aware of This? The observations made support the use of temporally limited tourniquet placement during paralytic administration to assess patient seizure status and sedation levels. Mindful tourniquet use in this manner permits a more effective sedation and management protocol for SE patients coming into the ED and may outweigh the minor risks associated with short-term hypoperfusion. |
| Databáze: | OpenAIRE |
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