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Valium, Ativan or Versed?


fireflymedic

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Which is more your choice for premedication and seizure cessation? We carry all three on our trucks and was curious as to the pros and cons of each. It seems if an IV is established, Ativan seems to be the choice (though the down side is the refridgeration issue making it impractical for many services to carry) but if not, Versed is chosen, though some of the older medics tend to go with valium for everything. I know Ativan has a longer duration and protection for seizures than valium, but as far as premedication, I haven't really seen a difference. What are your thoughts.

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Ativan is the drug of choice for seizures if available otherwise valium. The half life of versed is to short for use in seizures. If by premedication you mean preparing a breathing patient for intubation then I would say versed is the drug of choice. I give 100mg of lidocaine, 4mg versed, and 100mcg of fentanyl when I need to put a patient down for intubation in the prehospital arena. This has worked well for me and although I would prefer other drugs these are the only ones available in my system. I do adjust the dosages based on size and age.

We don't carry ativan but will probably add it to our drug boxes in the near future. I'm under the impression that refrigeration is no longer a concern with ativan.

Live long and prosper.

Spock

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Ditto Spock.

Versed is garbage when dealing with CNS events like seizures. It just doesn't last long enough. On the plus side, you can atomize it to be given nasally. I prefer Valium for most things. It gives a good balance of onset/duration between the other two, and we've been using it forever. For assisting with intubation, Versed is good stuff, as long as the patient doesn't have a trismus response. Ativan is good for prolonged sedation as well.

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I know Ativan has a longer duration and protection for seizures than valium, but as far as premedication, I haven't really seen a difference. What are your thoughts.

Untrue.

Diazepam has the longest halflife of the drugs you mentioned, by quite a margin.

We don't carry lorazepam. Diazepam is the standard medication for seizures here prehospital, with midazolam being mainly an IM/IN route. There is plenty of evidence on the effectiveness of IN midazolam including these boards. Plus of the drugs mentioned only midazolam can be given IN.

I think most would agree, if you are sans IV that IN versed is a much more pleasant (and effective) route of administration than PR (especially in an adult).

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much of the literature I have read, and listened to other medics throughout the area have a clear preference for ativan (if available to them). However, I was under the impression that valium has effectiveness of approx 20 min (which is why they caution you to watch for seizure recurrance) and that ativan provided protection for up to 4-6 hours. There is one service near us which ONLY uses versed with seizures (used to use valium, but was changed over recently-don't know reasoning behind that). I agree versed is good for cardioversion or to put someone down to tube, though the medics I have spoken with that use it for seizures in the nearby county state more respiratory issues with versed than valium or ativan (of course if wishing to tube, that would not provide a problem). I was just curious how things went in other areas and the popularity of the drugs. Also another interesting thing, I've found is patients tend to remember more when under the influence of valium than ativan and versed (versed they forget all, how lovely)....just a strange but almost comical observation. I've had patients tell me things I've said when I thought they were out and everything. Comical indeed.

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We carry Versed and Ativan.

Versed is for RSI (after Etomidate), conscious sedation, chemical restraint, and Sz. Ativan is used for Sz, chemical restraint and can be used for long term sedation during RSI, although no one uses it for that purpose. I have found that Ativan is great for Sz as long as you have a line, it hasn't worked so well for me if I have to give it IM.

As for chemical restraint, Versed is my drug of choice, I haven't had any luck with Ativan, but it works good for anxity.

As for refridgeration of Ativan, the literature says either keep it in the fridge or it has a 60 day shelf-life out of the fridge.

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