Sometimes seizing patients don't respond to
benzodiazepines. In the RAMPART study they found that 18.5% of the
midazolam group and 25.8% of the lorazepam group were still seizing
upon arrival at the ED.
We
know that rapid termination of status epilepticus (SE) is
important, but what should EMS do when they are maxing out benzo's,
blood pressures are getting soft from all the meds, and the patient
is still seizing?!
In this
episode we discuss the role of ketamine in SE patients that are
refractory to front line treatments.