Jeffrey, sinced you asked about this from a pre-hospital point of view I
considered it was worth the cross post from the Emed-L list. Sorry if I was
wrong for this thought.
In South Australia we previously used IV Diazepam for administration by
paramedics only, Midazolam has allowed us to move the administration of an
anti-convulsive to our ALS officers as well. (They are authorised for
trauma cannulation only) This has all but ceased our calls for back up by
paramedics for anti-convulsant therapy and aided the patients remarkably.
It has also given the paramedics a 'back door' if the patient is convulsing
to such an extent that IV cannulation would pose a danger to both parties.
The paramedic can then just give the Midazolam IM.
Our protocols give a dose of 0.1mg per Kg up to a dose of 10mg IM or 3mg IV
up to a maximum dose of 9mg. From experience it pays to remember to
administer it IV slowly, rapid push tends to have a dramatic effect on the
patient's breathing. EG they don't for a while and ventilatory support is
Diazepam has now been removed from our paramedic drug kits and we all use
Midazolam as the anti-convulant drug.
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