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Midazolam seizure — DipIMC MCQ

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ModeratePre-Hospital PharmacologyMidazolam seizureDipIMC

A 45-year-old continues to convulse after 6 minutes. Intravenous access is not available and airway equipment is prepared. What is the most appropriate drug/dose?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: CBuccal or intranasal midazolam 10 mg

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

E is correct: Prolonged convulsive seizure should be treated promptly with a benzodiazepine by an available safe route. A is less suitable because this is not a definitive treatment for the condition described; B is less suitable because rapid IV benzodiazepine bolus carries avoidable respiratory risk; C is less suitable because a large initial opioid bolus risks hypotension and respiratory depression; D is less suitable because analgesia is important but does not replace the first physiological intervention. The most tempting alternative is therefore suboptimal because it either delays the time-critical pre-hospital intervention or sends the patient to the wrong level of care. The key DipIMC principle is focused cABCDE decision-making with early pre-alert, triage or retrieval escalation when the scene physiology demands it.

Reference: JRCALC Medicines Guidelines; Resuscitation Council UK; BNF