Midazolam (Versed)

Question 1

Class / Action

Answer 1

Tranquilizer (Benzodiazepine)

1. Hypnotic, Amnesic, Sedative, Anticonvulsant
2. Potent but Short-Acting, 3-4 times more potent than Diazepam
3. Has NO effect on pain

Question 2

Onset / Duration of Action

Answer 2

ONSET DURATION

1. IV/IO: 1.5-5min 1. IV/IO/IM/IN: 2-6hours
2. IN: 2-6min
3. IM: 15min

Question 3

Indications

Answer 3

1. Premedication sedation prior to Cardioversion
2. Acute Anxiety States
3. Seizures
4. Post-Intubation Sedation

Question 4

Contraindications

Answer 4

1. Known Hypersensitivity

2. Narrow Angle Glaucoma

Question 5

Precautions

Answer 5

1. Shock

2. May be accentuated by narcotics and/or alcohol

Question 6

Dosages / Administration

Answer 6

1. Give half-doses if pt is >60years old
2. Wait 1-2min between IN/IV Doses to evaluate response
3. Seizures:
   a. ADULT:
   i. 1st Choice: 10mg for pts >40kg, Single Dose IM, or
   ii. 2nd Choice: 0.2mg/kg of a 5mg/mL Concentration IN, or
   iii. 3rd Choice: 2mg Increments IV; Max Dose 0.1mg/kg or 10mg (whichever is less)
   b. PEDS:
   i. 1st Choice: 5mg for 13-40kg, Single Dose IM, or
   ii. 2nd Choice: 0.2mg/kg of a 5mg/mL Concentration IN; Max Dose 10mg, or
   iii. 3rd Choice: 0.1mg/kg SLOW IVP over 2min in No Greater than 2mg Increments; Max Dose 5mg
4. Anxiety Relief/Sedation: e.g. CPAP, Pre-Cardioversion, Behavioral- NOT ExDs (specific doses/routes in protocol sections):
   a. ADULT:
   i. 0.2mg/kg of a 5mg/mL Concentration IN, or
   ii. 2mg Incrememnts IV/IO; Max Dose 0.1mg/kg or 10mg (whichever is less), or
   iii. 0.1mg/kg SLOW IVP over 2min in No Greater than 2mg Increments; Max Dose 5mg
   iv. CONTACT MARY BRIDGE BASE STATION IF UNSURE
5. Excited Delirium Sedation:
   a. ADULT: 10mg IN/IM/IV
   b. PEDS: CONTACT MARY BRIDGE BASE STATION For Direction
6. Post-RSI:
   a. ADULT: 2mg IV/IO q 10min PRN
   b. PEDS: 0.1mg/kg SLOW IV/IO over 2min in No Greater than 2mg Increments, q 10min PRN. (Refer to Pt Weight/Age Chart in Protocols)

Question 7

Adverse Reactions

Answer 7

1. Drowsiness, Hypotension, Amnesia, Respiratory Depression, Apnea, Laryngospasm, Bronchospasm, Dyspnea, Bradycardia, Tachycardia, PVCs, Retching
2. May Decrease ICP in head injury patients
3. Causes nasal burning for 30-45sec post-IN Administration