SGEM#473: Did You Ever Have To Make Up Your Mind – Midazolam or Ketamine for Acute Agitation in the Pre-Hospital Setting

The podcast explores the debate surrounding the use of midazolam versus ketamine for acute agitation in pre-hospital settings. It highlights a recent study comparing the two drugs regarding the need for emergent airway support, finding no statistically significant difference in that primary outcome. The discussion touches on the historical preference for benzodiazepines like midazolam and the more recent popularity of ketamine, while also addressing concerns about potential adverse effects of both, such as respiratory depression or increased blood pressure. The speakers delve into the limitations of retrospective studies, including selection and information biases, and consider the external validity of the study's findings across different EMS systems and patient populations.