Josh is giving 0.1 mg/kg of Lorazepam (up to 8 mg)

Scott varies by scenario:

Nothing or 2 mg of lorazepam

Midazolam 5 mg IV

wait 2-3 minutes

Repeat Midazolam 5 mg IV

RAMPART dose of 10 mg IM up front

Midazolam 10 mg IV or IM (if patient did not get this dose in the field already)

Scott gives Ketamine 1mg/kg with his second dose of midazolam, or immediately following the first 10 mg dose in extended seizures

PMID [40186980]

Debate with First10EM on this Study

PMID: 39642307

Protocol from the study

We both start with Levetiracetam (Keppra) 60 mg/kg (max dose 4.5 g)

Give this whenever it is ready, but do not wait for it to work, if the patient is still seizing, move on to intubation and propofol

ESETT Trial looked at this dosing [10.1056/NEJMoa1905795]

Lacosamide (Vimpat)

400 mg IV over 5 minutes (See IBCC for additional dosing info)

Scott uses propofol and succinylcholine

Josh uses Ketofol and rocuronium (but lower dose, 0.5-0.6 mg/kg

have a low threshold to intubate these patients!!

We both use propofol. Scott would consider switching to high dose midazolam drip after 48 hrs if the pt is still seizing.

You need higher doses of propofol to stop seizures, 80-100 mcg/kg/min

These pts will all need norepi, bring it to the bedside immediately after intubation

Additional New Information

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