Midazolam (Versed)

 

Pediatric     Adult                       Note: a 5mg/ml concentration is recommended for IN administration.

 

INDICATIONS & DOSAGE: NH

Adult:

• Seizures (Seizures 2.19A): Midazolam 10 mg IM (preferred route) every 10 minutes or 5 – 10 mg IV/IN every 5 minutes,

• Excited/Agitated Delirium or extreme agitation (Restraints 6.3): Midazolam 5mg IV/IM/IN; may repeat once in 10 minutes.

• Uncontrolled Shivering (Hyperthermia 2.9): Midazolam 2.5mg IV/IN, may repeat once in 5 minutes or; 5mg IM may
  repeat once in 10 minutes

• Nerve Agents Organophosphate Poisoning (2.13): Midazolam 2.5mg IV/IN every 5 minutes; or 5mg IM every 10 minutes as needed.

• Suspected Sympathomimetic/Stimulant (Poisoning 2.18): Midazolam 2.5mg IV/IN, may repeat once in 5 minutes; or 5mg IM, may
  repeat once in 20 minutes.

• Procedural Sedation (Bradycardia 3.1 Tachycardia 3.6): Midazolam 2.5mg IV/IN, may repeat once in 5 minutes; or 5 mg IM, may repeat once in 10 minutes

• Combative (TBI 4.7): Midazolam 2.5mg IV/IN may repeat once in 5 minutes or; 5mg IM may repeat once in 10 minutes

• Anxiety with CPAP (CPAP 5.3): Midazolam 2.5mg IV/IN may repeat once in 5 minutes or; 5mg IM may repeat once in 10 minutes

• Post-Intubation Care (Nasotracheal Intubation 5.5 Orotracheal Intubation 5.6 SGA 5.7 RSI 7.3): Midazolam 2 – 5 mg IV, every 5 – 10 minutes as needed

• Physically Restrained (Restraints 6.3): Midazolam 5mg IM, may repeat once in 20 minutes; or 2.5mg IV/IN, may repeat once in 5 minutes

• Replacement for Etomidate/Ketamine in RSI (RSI 7.3): Midazolam 0.2 mg/kg IV; 0.1mg/kg IV for patients in shock

 

Pediatric:

• Seizures (Seizures 2.19P) :

  • 0.2mg/kg IM/IN (single maximum dose 8mg) repeat every 5 minutes; or

  • 0.1mg/kg IV (single maximum dose 4 mg) repeat every 5 minutes.

• Uncontrolled Shivering (Hyperthermia 2.9): Midazolam 0.1mg/kg IV/IM or 0.2mg/kg IN (single maximum dose 1mg)

• Nerve Agents Organophosphate Poisoning (2.13): Midazolam 0.2mg/kg IM/IN/IV, repeat every 5 – 10 minutes as needed.

• Procedural Sedation (Bradycadia 3.1 Tachycardia 3.6): Midazolam 0.05mg/kg IV/IN

• Combative (TBI 4.7): Midazolam 0.05mg/kg IV/IM or 0.1mg/kg IN (maximum dose 3 mg); may repeat once in 5 minutes

 

PEARLS

• Midazolam is the first line benzodiazepine in all New Hampshire EMS protocols. This is largely because it can be given via the widest variety of route, including IM and IN. No other benzodiazepine should be administered via these routes.

• IM/IN is the preferred route for midazolam where an IV has not been previously established.

• IM midazolam should be administered to the lateral thigh.

• For IN administration of midazolam use a 5mg/mL concentration.

• Administer benzodiazipines with caution in patients with signs of hypercarbia.

 

ACTIONS

Midazolam is a shorter-acting benzodiazepine central nervous system depressant that produces sedation and lack of recall.

CONTRAINDICATIONS

Known hypersensitivity and narrow-angle glaucoma.

 

CLASS

General anesthetic

WARNINGS

Midazolam does not protect against increase in intracranial pressure and bradycardia associated with intubation attempts.

SIDE EFFECTS

Respiratory:Respiratory depression, laryngospasm, bronchospasm, dyspnea.
Cardiovascular:PVC's, bradycardia, tachycardia, nodal rhythms,hypotension.

CNS:Retrograde amnesia, altered mental status, dizziness, prolonged emergence from anesthesia, etc.

GI:Nausea / vomiting, hiccoughs, coughing, etc.

Local:Pain, redness, swelling, burning at injection site, etc.