Question: I have a question about postictal patients and cardiac monitoring. I have been told two things by several other partners in past few weeks. Assume you are a regular seizure patient whom you have seen many times and he/she is in their normal postictal state and you are not suspecting brain trauma. Is there any clinical reason/need to put cardiac monitor (e.g. limb leads) on? Also assuming you have a 1 min transport time. I was told as per BLS standard you "must" but in the postictal section it mentions that the paramedic may consider enroute. Thanks.
Thanks for the question. The Basic Life Support Patient Care Standards in section 2-43 discussed the management of patients both post ictal as well as in active seizure. It describes that new seizures especially in patients over the age of 50 may be signs of a cardiac arrhythmia. Without question, seizures can be signs of severe hypotension as well as impending cardiac arrest. The "Guideline" noted on page 2-45 which states "Consider cardiac monitoring the post ictal patient enroute, especially if a cerebro or cardiovascular event is suspected".
It would be difficult on scene to rule out either of these two etiologies and as such, our recommendation would be to perform cardiac monitoring as soon as possible. In terms of the semantics of the wording, although the wording in the BLS PCS says "consider" we feel that the paramedic "should". Further, the wording of "enroute" to us means as soon as possible as even during extrication from the scene, you are effectively "enroute" to the hospital.
Bottom line: The SWORBBHP Medical Council feels that cardiac monitoring of seizure and post ictal patients should be established as soon as reasonably possible by paramedics.