Critical Care Scenarios Episode 94: Mastering seizure pharmacology with Tom Bleck
Oct 15, 2025
Join neurointensivist Tom Bleck, a leading expert in seizure management, as he delves into the intricacies of seizure pharmacology. He breaks down the benefits of IM midazolam and discusses timing for treating seizures. Tom explains his preference for lorazepam in hospitals, the effective use of levetiracetam, and the emerging role of ketamine for benzodiazepine-resistant seizures. Learn when to intubate, how to manage refractory seizures, and the importance of EEG in guiding therapy. A treasure trove of knowledge for anyone in critical care!
AI Snips
Chapters
Transcript
Episode notes
Choose Benzos By Access
- If no IV exists, give IM midazolam (10 mg, repeat once) for fastest seizure control. If IV is present, give IV lorazepam (4 mg, repeat once) as first-line benzodiazepine therapy.
Why Benzos Lose Effect Over Time
- Benzodiazepine efficacy falls with seizure duration due to GABA-A receptor internalization and replacement. NMDA activation and calpain-2 driven receptor changes likely drive benzodiazepine tachyphylaxis.
Dose Benzos By Weight In Hospital
- Use lorazepam 0.1 mg/kg IV as an evidence-based hospital dose, giving 4 mg aliquots then the remainder to reach 0.1 mg/kg if needed. If seizures persist after a couple minutes, move to a second-line ASM rather than infinitely escalating benzos.