OCEMS MIDAZOLAM

Midazolam (Versed) Overview

• Classification: Benzodiazepine, Anticonvulsant

• Effects/Characteristics:

  • Potentiates GABA receptors

  • Produces sedation

  • Induces amnesia

  • Relaxes muscles

  • Halts and prevents seizures

Pharmacokinetics

• Onset of Action:

  • 2-5 minutes (Intravenous & Intraosseous)

  • 6-14 minutes (Intranasal)

  • 15 minutes (Intramuscular)

• Peak: N/A

• Duration: 1-6 hours

Dosage Forms

• Available Forms:

  • 5 mg/1 ml Ampule

  • 5 mg/1 ml Vial

  • 5 mg/1 ml Carpuject

Prehospital Routes of Administration

• Routes:

  • Intravenous

  • Intraosseous

  • Intramuscular

  • Intranasal

Treatment Protocol

• SO-C-020 Symptomatic Bradycardia (Adult):

  • Administer midazolam (up to 5 mg IV slowly titrated at 1 mg/min) if transcutaneous pacing causes anxiety and extreme discomfort with BP >90 systolic.

• SO-M-030 Psychiatric/Behavioral Emergencies (Adult):

  • For patients in toxic delirium, transport to nearest ERC; administer 5 mg IM/IN/IV once if agitation interferes with loading.

• SO-M-040 Seizure/Convulsion (Adult):

  • Administer 10 mg IM once, preferred route; if unable, use 5 mg IN/IV/IO with possible repeat of 5 mg after 3 mins for recurrent activity.

• SO-M-050 Substance Overdose/Poisoning (Adult):

  • If the patient is agitated and a danger to self or others, sedate with 5 mg IV/IM once.

• SO-M-080 Sedation for Endotracheal Intubation (Adult):

  • If BP ≥ 90, consider sedation with 5 mg IV/IO/IM once.

• SO-P-075 Seizure/Convulsion (Pediatric):

  • Administer 0.2 mg/kg IM once (max 10 mg), or 0.1 mg/kg IN/IV/IO if unable to deliver IM. Repeat once after 3 mins for continued seizures (max single dose 5 mg).

• BH-P-050 Ventricular Tachycardia with a Pulse (Pediatric):

  • Consider sedation for cardioversion if BP >80 mmHg using 0.1 mg/kg IN/IM (max single dose 5 mg).

• BH-P-055 Supraventricular Tachycardia (Pediatric):

  • Consider sedation for cardioversion if BP >80 mmHg using 0.1 mg/kg IN/IM (max single dose 5 mg).

Side Effects

• CNS depression

• Respiratory depression/arrest

• Hypotension

• Additional Notes:

  • Rapid onset and recovery time as an effective IV sedative.

  • Hypotension, if present, is typically transient and responsive to fluids.

  • Potentiates effects of other CNS depressants, especially in alcohol intoxicated patients.

  • Monitor respiration and oxygenation following administration using ETCO2 and SPO2.

  • Caution: This medication is classified as a controlled substance.

  • Administer IV/IO push at a rate of 1 mg/min; IM/IN is preferred route for combative patients.

Last Updated

• 9/9/24