A 22-year-old street vendor, was found in the park having a seizure. Cops brought him to ER, unaware of any background medical history. He is continuously having seizures for 13 minutes and paramedics are not able to gain intravenous access. You ensure the airway is secure and administer oxygen, however, you are unable to gain intravenous access after two attempts. Blood glucose levels are 80mg%. Which medication would be most suitable to administer at this stage to treat patient’s seizure?

**Core Concept**
In the setting of suspected seizures with inability to establish intravenous access, the primary concern is to rapidly terminate the seizure activity to prevent further complications such as status epilepticus. The chosen medication should have a rapid onset of action, minimal side effects, and a well-established safety profile.

**Why the Correct Answer is Right**
In this scenario, intramuscular midazolam is the most suitable option. Midazolam has a rapid onset of action (within 1-2 minutes), making it ideal for terminating seizure activity in an emergency setting. It also has a favorable pharmacokinetic profile, with minimal side effects and a short duration of action, allowing for easy reversal if needed.

**Why Each Wrong Option is Incorrect**
**Option A:** While lorazepam is a benzodiazepine commonly used in seizure management, its onset of action is slower compared to midazolam, making it less suitable in this scenario.
**Option B:** Intramuscular diazepam is another option, but it has a slower onset of action compared to midazolam and is less commonly used due to its variable absorption and potential for adverse effects.
**Option C:** Intravenous fosphenytoin is an antiepileptic medication, but it requires intravenous access, which is not feasible in this scenario.
**Option D:** There is no indication of the use of intramuscular valproate in acute seizure management.

**Clinical Pearl / High-Yield Fact**
In emergency situations where intravenous access is not feasible, intramuscular midazolam is a reliable and effective option for rapidly terminating seizure activity.

**Correct Answer:** C. Intramuscular midazolam.

✓ Correct Answer: C. Midazolam