Ketamine to the Rescue in Status Epilepticus?

This transcript has been edited for clarity.

Robert D. Glatter, MD: Hello and welcome. I'm Dr Robert Glatter, advisor and editorial board member for Medscape Emergency Medicine.

Managing patients with refractory status epilepticus can be quite challenging for all clinicians. Traditional approaches have utilized benzodiazepines, such as lorazepam, midazolam, and diazepam, along with loading antiepileptic medications, including levetiracetam, valproic acid, and propofol. When such a process fails to control seizure activity, using ketamine may offer superior control for refractory status epilepticus.

Here to discuss this is Dr Peter Antevy, an EMS physician and medical director for Coral Springs–Parkland Fire Department, along with Dr Ken Scheppke, an EMS physician and chief medical officer for Palm Beach County Fire Rescue in Florida. Welcome, gentlemen.

Kenneth A. Scheppke, MD: Thank you.

Peter M. Antevy, MD: Thanks, Rob.

Glatter: This is such an important topic. All of us take care of seizure patients pretty commonly in the emergency department (ED). Ken, I want to start off by asking you how you manage typical status epilepticus patients in the ED. Also, can you talk about refractory status epilepticus and your approach to management?

Scheppke:Both Peter and I are subspecialty board-certified EMS, so our arena is actually the prehospital field.