Versed

versed

I rank Versed 20 out of the 33 drugs we carry. If we did not also carry Ativan, I would have ranked it much higher.

We use Versed for a number of purposes.

1. We give it IM (intramuscular) or IN (intranasal) to seizing patients if we are unable to get an IV. If we get an IV we give Ativan.

2. As post intubation sedation for patients who start to buck the tube.

3. As sedation for patients who we pace or cardiovert.

4. To reduce shivering in patients with return of spontaneous circulation (ROSC) who we have initiated the hypothermia protocol on.

I have given Versed IM several times to seizing patients, but have yet to have it work well. In each case however, I was able to get an IV and give Ativan, which ended the seizures. Whether or not the Versed would have eventually done the trick, I donít know. We just got the intranasal indication for Versed, but havenít yet gotten our drug changed to the proper concentration to give it IN so I havenít obviously used it this way yet.

I have used versed postintubation and found it worked great. We recently allowed Ativan to be used this way as well. I still use Versed.

I have never used it for pacing or cardioversion (I havenít paced or cardioverted anyone since we got the indication), but I have used it many times for patients whose internal defibrillators were going off.

This seems to be an increasingly common call. Perhaps because more and more people are getting the devices. I have had some patients tell me that their doctors have told them only to call 911 if the defib goes off more than once. While I have had some people call after one firing Ė these are usually patients who are experiencing it for the first time Ė most patients who call are having to go off with some frequency. Once I had a patient have his go off while he was testifying before the state legislature. I can only imagine how that looked. Maybe it appeared like the chairman of the committee was zapping him because he didnít like his answers. It is quite painful to observe. I usually give Vered and Amiodarone (if I see VT on the monitor), and have had very good results (although sometimes I think their defibs stop firing because they have stopped walking around and are now resting). A couple times I have had patients who reported 20 plus firings and who fired actively in front of me, but then never fired again once they laid down on the stretcher. Sure I gave them amiodarone, but it took awhile for the IV and then 10 minutes to drip the amio in.

I have also used Versed as part of the induced hypothermia protocol.

***

Midazolam (Versed)

Class: Benzodiazepine (short acting)

Action: CNS depressant

Effect: Sedation

Indications: Pre-cardioversion; TCP; seizure control; sedation post-intubation

Dose: 2-5 mg (0.1 mg/kg); Administer 50% dose to patients >70 years old: IN dose:
Adults over 50kg, 10mg (2ml) of Midazolam; Pediatrics 0.2mg/kg not to
exceed 10mg.

Route: Slow IV push; IM; IN

Side Effects: Decreased level of consciousness
Hypotension
Respiratory depression

Special Information: Any patient receiving Versed must be closely monitored. This
must include (if physically possible) pulse oximetry, ECG, capnography (if
available), all vital signs and respiratory effort.

For IN doses, load syringe with appropriate milliliter volume of midazolam
(use only 5mg/ml concentration) and attach MAD nasal atomizer . Administer
half volume as atomized spray to each nostril.

3 Comments

  • CBEMT says:

    In their infinite, all-knowing wisdom, our state pulled Valium in favor of Versed for siezures. Now we’re due to get Valium back as soon as the revision comes through.

    Guess they discovered the same thing you did.

  • Les Wiles says:

    Your Versed dosing guidelines are as weak as ours! I have had two complicated airways – one traumatic (auto-ped) and the other from a crack cocaine overdose (BP > 280 Systolic over 160 Diastolic/Manual Cuff. Both times the transport paramedics refused to give additional doses (more than 10mg IV Slow Push) because they were protocol whipped! I have spoken to the Medical Control Board about these 2 cases and they agreed on increasing the Midazolam dosages in these situations. IT should be noted that in our system we do not have the capabilities for a RSI procedure.

  • Medic In Training says:

    Here is another drug we do not carry including the Ativan! We use Valium and we cannot even do RSI in my area. I think I need to move to another area to get some real experience!

1 Trackback

Leave a Reply

Your email address will not be published. Required fields are marked *

background image Blogger Img

Peter Canning

JEMS Talk: Google Hangout

Recent Posts
SW_Rectangle The Jug March 26, 2015
SW_Rectangle The Ideal Medic March 24, 2015
The Butler Did It February 19, 2015
Medicscribe_Header Gifts January 25, 2015
Categories
  • ems-health-safety (7)
  • ems-topics (702)
  • hazmat (1)
  • Uncategorized (420)
  • Comments
    Ihunanya udochu
    AHA 2015 Guidelines: A Preview
    Airway protection is important in a cardiac arrest patient especially endotracheal intubation unlike supraglottic airway which does not and there is risk of aspiration.A paramedic should learn how to intubate the trachea, pass an LMA and NG tube. Protecting the airway shouldn't be enough, paramedics should know how to position his hands, and also the…
    2015-04-07 15:56:27
    medicscribe
    No Chest Compressions
    You can't do CPR without chest compressions. If you don't do chest compressions it is not CPR. The patient's heart has stopped. Aside from opening their chest and doing cardiac massage, there is no way to make the heart pump without doing chest compressions. Chest compressions are by nature traumatic. Ribs are often broken by…
    2015-04-01 21:24:02
    Anonymous
    No Chest Compressions
    Actually, as a decision maker for an individual with osteoporosis I am facing this dilemma now. Guidance in our state's code suggests that I do not consent to a DNR unless there is a compelling reason - such as terminal illness. However, I am aware that manual CPR would be devastating to the body of…
    2015-04-01 20:57:01
    Mike
    You Don't Have to Put on Your Red Lights
    I totally understand what you guys are saying and how you feel. It's a shame that because there are bad apples in a basket, we as people think the whole basket is bad and this is so far from the truth. I was an EMT for a little while, it was my part time job…
    2015-03-29 15:05:53
    Sandy
    The Ideal Medic
    As a 24 year medic, I finally figured out it wasn't me. Thank you for your article. You can't teach that in any classroom. I have always found that empathy is a great tool. Use it to benefit the patient and teach others what it is all about.
    2015-03-24 22:24:30

    Now Available: Mortal Men

    Mortal Men is available as an electronic book for Kindle, Nook or any other e-reader. Here is a link to some of the places to buy it. The book sells for $3.99. Barnes and Noble Amazon Smashwords Scribd Also Available from iBooks

    Order My Books

    Support EMS Bloggers, Buy Their Books

    Google

    Order Books and Movies

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS