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!

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Peter Canning

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