Download Midazolam (Versed) - Paramedic Protocol Provider

Midazolam 2017
Class:
♦ Benzodiazapine, anticonvulsant
Actions:
♦ Provides sedation without loss of consciousness
♦ Provides relief of anxiety
♦ Provides antegrade amnesia
♦ Benzodiazapines as a whole elevate seizure thresholds
Indications:
♦ Sedation, anxiolysis, and amnesia prior to cardioversion or pacing in conscious patients
♦ Sedation to facilitate advanced airway compliance
♦ Situations where chemical restraint is needed to care for the patient or protect responders or
bystanders – adult only
♦ Patients actively seizing or experiencing ongoing seizure activity
♦ Excited Delirium Syndrome
♦ Suspected nerve agent poisoning
Dosage/Administration:
 Adult:
• Treatment of seizure activity:
o If no IV/IO, 10 mg IM, repeat at 5 mg every 5 min until termination of seizure
activity IV/IO/IM/IN, to a max of 20 mg
o If IV/IO is established, 5 mg IV/IO, repeat at 5 mg IV/IO every 5 min to max of 20 mg
• Sedation prior to cardioversion, chemical restraint, and when needed to facilitate
compliance with positive pressure ventilation, to facilitate CPAP application in an anxious
patient*:
o 2.5 - 5 mg IV/IO/IM/IN, repeat PRN in 5 minute intervals to a max total dose of
10 mg.
* Use cautiously with elderly, debilitated, or chronically ill patients
• For use with Excited Delirium Syndrome:
o 5 - 10 mg IV/IO/IM/IN, repeat PRN in 5 minute intervals to a max total dose of
20 mg.
Note: dosage must be individualized and titrated to desired effect. Individualized response may vary with
age, physical status, and concomitant medications but may also vary independent of these factors.
 Pediatric:
• Treatment of seizure activity:
o If no IV/IO, 5 mg IM for any patient 13-40 kg (29-88 lbs - Yellow-Green on Peds card),
repeat at 2.5 mg IM/IN every 5 min until termination of seizure activity to a max
total dose of 10 mg
Johnson County Emergency Medical Services Protocols
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Midazolam 2017
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•
Once IV/IO is established, wait 5 minutes from initial administration, then
administer 2.5 mg PRN x2 IV/IO to a max total dose of 10 mg.
o If IV/IO is established, administer 2.5 mg IV/IO for seizure activity. Repeat at 2.5 mg
every 5 min to a max total dose of 10 mg or termination of seizure activity.
o If patient weight is less than 13 kg (<29 lbs), Administer the following to a max total
dose of 10 mg or until termination of seizure activity:
 0.1 mg/kg IV/IO/IM, repeat PRN in 5 minutes
 0.2 mg/kg Intranasal, repeat PRN in 5 minutes
Sedation prior to cardioversion, chemical restraint, and when needed to facilitate
compliance with positive pressure ventilation:
o 0.1 mg/kg IV/IO/IM, repeat PRN in 5 minute intervals to a max total dose of 10
mg.
o 0.2 mg/kg Intranasal, repeat PRN in 5 minute intervals to a max total dose of 10
mg.
Side Effects:
♦ Drowsiness, fatigue, dizziness, confusion, nausea, vomiting
♦ Respiratory depression and hypoventilation, with possible apnea
♦ Hypotension (rare)
♦ Reactions such as agitation, involuntary movements (including tonic/clonic movements and
muscle tremors), hyperactivity, and combativeness have been reported
Contraindications:
♦ Hypersensitivity to benzodiazepines
♦ Narrow angle glaucoma (relative contraindication)
♦ Shock
Johnson County Emergency Medical Services Protocols
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Midazolam 2017
Precautions:
♦ Pulse oximetry and cardiac monitoring must be in place as well as continuous monitoring of
respiratory status
♦ Use with caution in renal impaired patients, due to altered pharmacokinetics
♦ Use with caution in CHF patients due to delayed onset of action and long half-life
♦ Geriatric patients and/or COPD patients are more susceptible to the respiratory depression
associated with midazolam administration
♦ Concomitant use of barbiturates or other CNS depressants may increase the risk of
hypoventilation and may contribute to profound and/or prolonged drug effect
Protocol Reference:
♦ IPAP
♦ Dysrhythmias
♦ Excited Delirium Syndrome
♦ Patient Restraint
♦ Post Resuscitation
♦ Respiratory Distress
♦ Seizures
♦ Appendix G: DuoDote Kit
Johnson County Emergency Medical Services
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