Midazolam (Versed®)

(Optional medication – not required for every BioTel agency)

Indications:

• 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

Contraindications:

• Known hypersensitivity
• Acute narrow-angle glaucoma

Precautions:

• Monitor respiratory status closely: prepare for BVM assisted ventilation
• Give at the site closest to the IV/IO insertion site and avoid mixing with any other drugs and solutions; flush well before and after use
• Titrate in small boluses to avoid adverse side effects

Side Effects:

• Respiratory depression
• Hypotension
• Stupor
• Nausea
• Confusion

Adult Dose:

• Standing order doses:
  • 0.1 mg/kg IV/IO push (maximum single dose of 5 mg) for sedation prior to Pharmacologically-Assisted Intubation (PAI):
    • Note:  BIOTEL AUTHORIZATION is required for all non-PAI agencies as an adjunct to facilitate endotracheal intubation.
  • 2.5 mg – 5 mg IV/IO/IM, or 5 mg IN to maintain sedation and endotracheal tube placement following ROSC.
    • May repeat once.
  • 2.5 mg – 5 mg per dose titrated to achieve all other desired clinical effects:
    • Maximum cumulative total IV/IO/IM dose: 5 mg.
    • Maximum cumulative total IN dose: 10 mg.
• BioTel may order additional doses beyond standing order doses.

Pediatric Dose:

Standing order:

• Seizures
• INTRANASAL
  • 1 to 6 months of age: 0.2 mg/kg up to a maximum single dose of 1 mg.
  • Over 6 months of age: 0.2 – 0.3 mg/kg, up to a maximum single dose of 5 mg; divide the dose between both nostrils, if possible.
• INTRAVENOUS or INTRAOSSEOUS
  • 0.15 to 0.2 mg/kg up to a maximum single dose of 5 mg
• Maintain sedation and endotracheal tube placement following ROSC:
• 0.1 mg/kg IV/IO/IM/IN (maximum SINGLE dose 5 mg).
  • May repeat once.

BIOTEL AUTHORIZATION REQUIRED

• Sedation (with fentanyl) prior to pharmacologically-assisted intubation (PAI):
  • 0.1 mg/kg IV/IO/IN/IM
• Excited Delirium and any other use in the pediatric patient

Route:

• IV or IO; IM
• Intranasal (IN) rapid Push
  

Drug Action:

Central nervous system depressant that causes:

• Amnesia
• Sedation
• Muscle relaxation

Class: Benzodiazepine

Onset: Highly variable, however usually 1 – 5 minutes

Duration: Variable; however, usually 15 minutes to 1 hour