TY - JOUR T1 - Intranasal midazolam JF - Emergency Medicine Journal JO - Emerg Med J SP - 217 LP - 218 DO - 10.1136/emj.2008.069658 VL - 26 IS - 3 AU - R Owen AU - N Castle Y1 - 2009/03/01 UR - http://emj.bmj.com/content/26/3/217.abstract N2 - 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: ClearBreathing: Spontaneous with Spo2 98% on 40% oxygenCirculation: Pulse 100/minDisability: 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.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 … ER -