Sometimes seizing patients don't respond to benzodiazepines. In the RAMPART study they found that 18.5% of the midazolam group and 25.8% of the lorazepam group were still seizing upon arrival at the ED. We know that rapid termination of status epilepticus (SE) is important, but what should EMS do when they are maxing out benzo's, blood pressures are getting soft from all the meds, and the patient is still seizing?! In this episode we discuss the role of ketamine in SE patients that are refractory to front line treatments.