Episode 964: Ketamine & Midazolam for Prehospital Seizure Management

Episode 964: Ketamine & Midazolam for Prehospital Seizure Management

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

  1. 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

Donate: https://emergencymedicalminute.org/donate/

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Episode 979: Oral vs Temporal Thermometers

Episode 979: Oral vs Temporal Thermometers

Contributor: Taylor Lynch, MD Educational Pearls: A recent study published in a pediatric journal in April 2025 compared temporal and oral thermometers Paired temperature measurements (temporal and o...

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Episode 978: Delusional Parasitosis

Episode 978: Delusional Parasitosis

Contributor: Taylor Lynch, MD Educational Pearls: Delusional parasitosis is a subtype of the psychiatric condition delusional disorder Defined as a fixed, false belief of infestation by parasites or...

13 Loka 20253min

Episode 977: Amyloid Therapy and Stroke-like Events

Episode 977: Amyloid Therapy and Stroke-like Events

Contributor: Aaron Lessen, MD Educational Pearls: The cause of Alzheimer's disease is multifactorial, but the most widely suspected mechanism is the amyloid cascade hypothesis: Beta-amyloid proteins ...

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Episode 976: Improvised Burr Hole in an Epidural Hematoma

Episode 976: Improvised Burr Hole in an Epidural Hematoma

Contributor: Alec Coston, MD Case Report Summary: A 17-year-old female involved in a motor vehicle collision presented to a rural emergency facility via personally operated vehicle. During workup and ...

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Episode 975: Nursemaid's Elbow

Episode 975: Nursemaid's Elbow

Contributor: Aaron Lessen, MD Educational Pearls: What is a Nursemaid's Elbow? A condition in which an elbow gets partially pulled out of place (a radial head subluxation) Usually happens in kids und...

22 Syys 20253min

Episode 974: ACE Inhibitor Angioedema

Episode 974: ACE Inhibitor Angioedema

Contributor: Ricky Dhaliwal, MD Educational Pearls: Angioedema in anaphylaxis Histamine and mast cell-mediated pathway Treatment: First line: epinephrine for vasoconstriction and bronchodilation Se...

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Emergency Medicine Cases with Dr. Barlock

Emergency Medicine Cases with Dr. Barlock

Contributors: Travis Barlock MD, Jeffrey Olson MS4 Feel free to use the cases below for your own practice. All of the scenarios are completely made up and designed to hit several teaching points. Case...

9 Syys 202553min

Episode 973: Meningitis Retention Syndrome

Episode 973: Meningitis Retention Syndrome

Contributor: Travis Barlock MD Educational Pearls: Meningitis retention syndrome is a relatively novel and rare clinical condition Aseptic meningitis + acute urinary retention One study reports an i...

8 Syys 20252min

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