National shortage of Valium

[portland medic]

We've been using versed for years. I'm a big fan of it for several reasons;

1) It is very potent. When given IV, you will see it's effects VERY quickly, and see a marked change in the pt.

2) It has a half-life that is more conducive to EMS, ie short. We used to give ativan for seizures and it infuriated the docs and the RN's due to how long people were snowed for. (our main county ED is very busy and moving people out is a priority, for better or worse).

3) it can be given IM no problem, without the oily viscosity associated with many other benzos. When we used to give ativan, we had trouble drawing all of it up into the syringe it was so oily. Versed does not have that problem.

4) simple dosing regimen. 0.1mg/kg -.2mg/kg for kids IM/IV, 2.5 - 10mg for adults titrated. In general we start with 5mg IM, and 2.5mg IV for seizures and as a chemical restraint or for hyperadrenergic syndrome.

5) it is the single greatest and most effective med Ive ever given as a chemical restraint. It can be given IM, then you just wait a few minutes for the snoring to start. Beautiful.

However, beware of giving versed with other CNS depressants, particularly opiate pain meds. My partner once made a pt stop breathing with 10mg of morphine and 2mg versed. The MS wasnt working on a pt with a severely painful fracture. he gave 2mg versed IV as an adjunct and bam, he was giving a kiss of narcan to wake him up. OOPS! Dont worry though. Its a great medication.

[tcripp]

Versed will do that with or without the MS. Well...that's what I've been told. (giggle)

[Chief1C]

Damn... Because I COULD REALLY USE A VALIUM.

[Kiwiology]

My partner once made a pt stop breathing with 10mg of morphine and 2mg versed. The MS wasnt working on a pt with a severely painful fracture. he gave 2mg versed IV as an adjunct and bam, he was giving a kiss of narcan to wake him up. OOPS! Dont worry though. Its a great medication.

Morphine + midazolam is something we've had for about ten years, but we use very small doses i.e. 1mg IV at a time, some might even go so far as to give 1mg followed by 0.5mg doses as required

It was very popular here but has fallen way out of fashion since we got ketamine

[systemet]

* It's onset is more rapid, the drugs less potent, so you see lower dosing with Versed vs. Valium

I misspoke here. This should read "the drug is more potent".

[Edit, pasted twice.]

Edited November 2, 2011 by systemet

[hatelilpeepees]

McKesson has valium available in vials, but no bristojet type valium

[Kiwiology]

McKesson has valium available in vials, but no bristojet type valium

I will never understand the American fascination with bristojet (the Johnny and Roy screw-together type) drug preparations

All of our drugs come in glass ampoules or plastic snapoules

We looked at pre-filled (bristojet) adrenaline but they are very expensive, an ampoule of adrenaline and a filter needle costs about $2

Edited November 2, 2011 by kiwimedic

[krumel]

We use Midazolam for years now and are pretty happy with it...

You can administer it in almost every way...i.V., i.O., rectal, i.m., i.n.... And it works always fast, "potent" and proper.

I can only remember two incidents were I had severe problems with midazolam...

Both were related to alcohol...

One was a 110kg female Patient found in a public park "somewhere in the Bush"... Massive convulsions, not possible to gain i.V. access.

Gave 2.5mg Midazolam intranasally... Patient stoped breathing a minute later. We found ourself in a "can not ventilate, can not intubate situation". Had to use flumazenil to bring us out of this situation.

On ICU they monitored a 4.2 promil alcohol blood level...Problem was: Due to the heavy smells on scene we did both not smell the ethanol...and no other obvious signs of alcohol consumption were visible.

Another patient, 79 year old female, former alcohol addict, had some kind of paradoxical reaction. A significantly increased dosis helped managed it...

Key point: Be aware of the danger of Midazolam in combination with alcohol... The effects are bigger in comparison with valium.

[HERBIE1]

Yeah, we had a memo come out about this as well. We also were told to use Versed in lieu of Diazepam. We recently started carrrying it for chemical restraint and for intractable seizures in kids but our first line med is still Valium. We do not carry Ativan, so it's not even an option.

[usalsfyre]

The "abuse allegation" argument seems to be borrowing worry. Midaz, within it's proper dozing range, acts like any other benzodiazepine, with perhaps a bit faster onset. I've used a ton of the stuff over the years with no issues other than one can't intubate, hard to ventilate patient who ended hypotensive (why I'm so against midaz only intubation).

One if the issues I've seen is that diazepam is often underdosed in EMS protocols, meaning when given midaz at proper dosing ranges providers are often surprised at the effect the upper range if the dosage range has.

I've used midaz for seizures, RSI, post-intubation sedation, chemical restraint, pain control in conjunction with opiates and anxiety with no issues. Safe an effective med, and I love you can give it IN.

Edited November 2, 2011 by usalsfyre