Midazolam seizure — DipIMC MCQ
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Correct answer: C — Buccal 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