versed protocols in the field

[emtintraining31]

Hi everyone, I am currently a emt student in Texas, and need your guys opinion as to something that happened to a friend of mine. She was recently diagnosed with epilepsy, just started having a seizure towards the end of may for the first time. She has since been diagnosed with Complex partial seizures. Paramedics had been called out approximately 2 times before this incident that happened in june. local 911 was called out on a 32 year old female seizing on june 10, when paramedics arrived pt was actively seizing, family told medics that she had been down approximately 10 minutes before calling 911, paramedics pushed 10 versed im, no response, pt. still actively seizing, an additional 20 of versed was pushed im, attempts were made for iv access, however, unsucessful, pt was transported to local hospital. er physician informed family that she was being admitted to icu because she had been actively seizing for over an hr and had went into v-tach during seizure at hospital. after speaking with several friends in the medical field, who are paramedics and emts they advised me that they can only push a max of 15 mg in the field and that only a er doc can push a max of 25 mg versed. I was just curious as to your guys protocol. Thank you.

[medic001918]

We have versed in our protocols, we can give 5 mg IM on standing, and can call for an additional 5 mg. Our front line drug for seizures though is Ativan. We can give 2mg IV every 5 minutes to a max of 8 mg.

It sounds like she got a pretty hefty amount of medication to try to control her seizure. I'm guessing there was some other underlying cause if that much medication didn't control them.

Shane

NREMT-P

[BushyFromOz]

after speaking with several friends in the medical field, who are paramedics and emts they advised me that can only push a max of 15 mg in the field and that only a er doc can push a max of 25 mg versed.

No offence "dude", but your friends are idiots for 2 reasons

1) not everybody has the same standing orders, hence bold highlighting of "they", as in your friendd

2) Your "friends", as in "paramedics and emt's" should not presume to know what a doctor can/cannot do. There is a reason why one went to university and the other went to first aid college :wink:

-5 for not having paragraphs

[BushyFromOz]

Okay, I don't want to look like I am just trying to rack up pointless posts to get into the chatroom, but...

:shock:

P.S. Minus 5 for posting in the wrong forum. :wink:

Bloody hell dust

6 and a half thousand posts and you STILL dont appear in the chat room, your failing miserably.......... how can anyone trust a paramedic who can't even achieve that?? Its like that bloke who failed his emt-b exam twice who complained that it was too hard

Go hard or go home, or , alternatively, go to the bottle shop 8)

[p3medic]

I don't have a max for versed. It woudn't be my first choice of benzo, but its certainly acceptable, and given the fact that your friend was still seizing, she could probably use a little more.....

[fireflymedic]

We have several options we can use for seizures, ativan being at the top of the list (though it's biggest disadvantage in many services is the need for refrig - and yes it DOES have to be !). Versed also comes into play, which we can give up to 10 IV standing or 20 IM and valium which we can give up to 20 IV and call for up to 10 more. Sounds like she was in pretty significant status though and probably ended up sedated and intubated as most are that keep going that long or go through that much meds. Remember all those are a respiratory depressant and you can knock 'em down enough to need to be bagged or even tubed so just keep a keen eye on that airway. Be safe out there.

[fiznat]

Jeez, 30mg of versed?? Thats a freaking LOT of benzo... I donno, we're not allowed to come even close to that kind of dose around here (like medic said, we do 5mg IM only, but prefer IV Ativan). Are you sure you've got your facts straight? I mean I was reading research on sedated intubation the other day and they were using similar versed dosages to obtain basically RSI-ish obtundation, and they were consistently worried about hypotension and all the other nastyness that comes from such high dosages.

I suppose it comes in different concentrations, but around here we get Versed in 1mg/mL... Assuming they have the same that means they put 30mL of fluid into a muscle? Jeeeeezz......

[chbare]

My employer carries Midazolam in the 5mg/ML concentration. It is not uncommon to push 0.1 mg/kg of Midazolam IV when talking about RSI doses. So, a 100 KG person could easily be given 10mg in one dose. Yes, hypotension is a concern when giving Midazolam. However, anyone with some ICU time has most likely seen patients on very high doses of Diprivan actually require Neosynephrine or other pressor to augment their blood pressure. In the OR, you may see much higher doses of Midazolam given.

I would be careful about using any specific number to generalize the maximum dose. While we may have protocols and guidelines, physicians may be administering doses of meds well over or under our guidelines on a regular basis.

Take care,

chbare.

[fiznat]

It is not uncommon to push 0.1 mg/kg of Midazolam IV when talking about RSI doses. So, a 100 KG person could easily be given 10mg in one dose.

Yeah, and this was 3 times that dose!

I understand that we all have different protocols and that people do different things all around the world, but I must say that it has been at least my experience that 30mg of Versed is an exceedingly high dose for seizures in the field. Is there anyone here at all who has, as an EMS provider, given this much?

[Dustdevil]

...I must say that it has been at least my experience that 30mg of Versed is an exceedingly high dose for seizures in the field. Is there anyone here at all who has, as an EMS provider, given this much?

Given that much?

Hell, that's three times more than I even carry. :?