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Question: Seizures

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EMS is bringing you a 10yo patient that has been actively seizing for 20 minutes. They are unable to obtain IV access.

Which medication / route will be the fastest onset for status epilepticus?

pemsou5_wp • November 17, 2020

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  1. Kelly November 18, 2020 - 7:58 pm Reply

    D) Intranasal midazolam
    Intranasal midazolam is likely to be slightly more rapid in onset than intramuscular midazolam. The appropriate dose is 0.2 mg/kg to a maximum of 10 mg, and the concentrated form of 5 mg/mL midazolam + a mucosal atomizer device should be used. If a MAD / concentrated midazolam is not available, IM midazolam at 5mg for 13-40kg, and 10mg for > 40kg is reasonably fast in onset (5-15 min). IM lorazepam’s duration of effect is longer, but the onset is also longer. Rectal diazepam onset of action is similar to IM midazolam, but less reliable. Fosphenytoin can be given IM, but the onset of action is on the order of 30 minutes.

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