Contributor: Aaron Lessen, MD
Educational Pearls:
- Prehospital seizures are typically managed with intramuscular midazolam (Versed)
- Seizures theoretically involve the NMDA pathway, and ketamine is a potent NMDA antagonist
- A recent retrospective cohort study analyzed a Florida EMS protocol that uses ketamine in seizures refractory to midazolam
- One group received two doses of midazolam for seizure control
- The other group received a dose of midazolam followed by a dose of ketamine
- After matching, 82% of the midazolam-only group patients had resolution of convulsions prior to ED arrival
- 94.4% of patients in the midazolam + ketamine group experienced resolution
- Absolute difference between groups was 12.4% (95% CI 3.1% to 21.7%)
- Limitations to the study include its prehospital setting and limited long-term follow-up
References
- Zitek T, Scheppke KA, Antevy P, et al. Midazolam and Ketamine for Convulsive Status Epilepticus in the Out-of-Hospital Setting. Ann Emerg Med. 2025;85(4):305-312. doi:10.1016/j.annemergmed.2024.11.002
Summarized & Edited by Jorge Chalit, OMS4
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