We were dispatched to provide advanced life support assistance to an ambulance crew. On our arrival we noted a malnourished adult who had been fitting continuously for >20 min:

Airway: Clear

Breathing: Spontaneous with Spo₂ 98% on 40% oxygen

Circulation: Pulse 100/min

Disability: Unresponsive with blood glucose >5 mmol

The patient’s malnourished condition made securing intravenous access difficult, so we elected to administer intranasal midazolam. Within 3 min, seizure activity had ceased and the patient’s conscious level gradually increased. Intravenous access was secured and the patient was transported to hospital with a paramedic escort.

DISCUSSION

The traditional prehospital approach to controlling convulsions is the administration of intravenous or rectal benzodiazepines. Gaining intravenous access during a seizure is difficult and places the clinician at risk from needlestick injury. Rectal administration is safer, but may be deemed socially unacceptable. In addition, diazepam has a prolonged half-life when administered rectally (20–40 h) compared with intranasal …