(Optional medication – not required for every BioTel agency)
Indications:
- Active seizure/status epilepticus or seizure related to eclampsia
- Procedural sedation prior to cardioversion or transcutaneous pacing in conscious patients or to facilitate endotracheal intubation
- Chest pain or tachycardia following an overdose or ingestion of a stimulant or hallucinogen (cocaine, amphetamine, ecstasy, LSD, PCP, ketamine)
- Excited delirium (sedation in struggling patients when physical restraints are applied)
- Maintain sedation following advanced airway placement using pharmacologically-assisted intubation (PAI) or post-cardiac arrest
Contraindications:
- Pregnancy (unless eclamptic seizure)
- All other uses in pregnancy require BioTel authorization
- Alcohol or other sedative drug use
- Head injury
- Hypersensitivity
Precautions:
- Monitor respiratory status closely.
- Administer at site closest to IV/IO insertion point.
- Avoid mixing with any other drugs and solutions.
- Flush well before and after use.
- Titrate in small incremental doses to avoid adverse side effects
Side Effects:
- Respiratory depression
- Hypotension
- Confusion
- Stupor
- Vein irritation, phlebitis, sclerosis
- Nausea
Adult Dose:
Standing order:
2.5 mg – 5 mg (up to a total cumulative maximum of 10 mg), titrated to achieve desired results
- For procedural sedation: Only 1 initial dose and 1 repeat dose
- BIOTEL AUTHORIZATION required for sedation to facilitate endotracheal intubation (Pharmacologically Assisted Intubation (PAI))
- BioTel may order additional doses beyond 10 mg
Pediatric Dose:
Standing order:
Seizure:
- 0.5 mg/kg per rectum (PR) (Maximum single dose: 10 mg), if midazolam is unavailable
All other indications require BioTel authorization
Route:
- IV or IO, slow push
- IM (alternate route)
- IN (not preferred)
- PR, for pediatric seizure
Drug Action:
Central Nervous System depressant that causes:
- Amnesia
- Sedation
- Muscle relaxation
Class: Benzodiazepine
Onset:
IV/IO/IN: 1 to 5 minutes
IM: 15 to 30 minutes
Rectal: 5 to 15 minutes
Duration:
IV/IO/IN: 15 to 60 minutes
Rectal: 2 to 4 hours