Midazolam (Versed®) (optional medication – not required in every BioTel agency)

• IV or IO push
  
• Intranasal (IN) rapid push

Adult Dose:

• Standing order doses of
  
  • 0.1 mg/kg IV push (maximum dose of 5 mg) for sedation prior to pharmacologically assisted intubation (PAI)
    
  • 2.5 mg – 5 mg (maximum IV dose of 5 mg; maximum IN dose of 10 mg) titrated to achieve all other desired effects
    
• BIOTEL AUTHORIZATION required for non-PAI agencies as an adjunct to facilitate endotracheal intubation
  
• BioTel may order additional doses beyond standing order doses

• Standing order dose for
  
  • Seizures
    • INTRANASAL
    • 1-6 months old:  0.2 mg/kg to a maximum initial dose of 1 mg
    • ≥ 6 months old:  0.2 – 0.3 mg/kg to a maximum initial dose of 5 mg
    • INTRAVENOUS
    • 0.15 to 0.2 mg/kg to a maximum initial dose of 5 mg
    o Maintain sedation and endotracheal tube placement following ROSC
    • Midazolam 0.1 mg/kg IV/IO/intranasal (maximum SINGLE dose 5 mg). May
    repeat once.
    
• Any other use in the pediatric patient requires BioTel authorization
  
• BioTel may order additional doses beyond standing order doses.

Central nervous system depressant that causes:

• Amnesia
  
• Sedation
  
• Muscle relaxation
  
  

• Active seizure/status epilepticus or seizure related to eclampsia
  
• Sedation prior to cardioversion or transcutaneous pacing in conscious patients or to facilitate endotracheal intubation
  
• Excited delirium (sedation in struggling patients when medical restraints are applied)
  
• Chest pain or tachycardia following an overdose or ingestion of a stimulant or hallucinogen (cocaine, amphetamine, ecstasy, LSD, PCP, ketamine)
  
• Maintain sedation following advanced airway placement using the pharmacologically assisted intubation procedure or if ROSC achieved following cardiac arrest

• Monitor respiratory status closely
  
• Give at site closest to IV catheter and avoid mixing with any other drugs and solutions; flush well before and after use
  
• Titrate in small boluses to avoid side effects

• Respiratory depression
  
• Hypotension
  
• Confusion
  
• Stupor
  
• Nausea
  

• Known hypersensitivity
  
• Acute narrow-angle glaucoma