EMS Branch / Office of the Medical Director. Active Seziures (d) Yes Yes Yes Yes. Yes Yes No No. Agitation (f) No Yes Yes No.

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1 M07 Medications All ages EMS Branch / Office of the Medical Director Benzodiazepines Primary Intermediate Advanced Critical INDICATIONS Diazepam (c) Lorazepam (c) Midazolam (c) Intranasal Midazolam Active Seziures (d) Yes Yes Yes Yes Alcohol or Drug Withdrawal (e) Yes Yes No No Agitation (f) No Yes Yes No Procedural Sedation (g) Sedation of Intubated Patient No No Yes No No No Yes No DOSE Appendix A Appendix B Appendic C Appendix D CONTRAINDICATIONS: Known or suspected hypersensitivity (NOTE: hypersensitivity to one drug of this group does not contraindicate administration of another) Respiratory depression or reasonable forseeable risk of same Hypotension Concomittant administration or ingestion (eg. overdose) of other CNS depressants NOTES: a. In the treatment of seizures, none of the above contraindications precludes the use of these medications. b. Administration of any of the above medications for any of the above indications requires continuus monitoring of respiratory and cardiac status. c. Never administer IV by bolus injection. Infuse slowly over 30 to 60 seconds. d. To be used for treatment of active seizures. DO NOT ADMINISTER POST-SEIZURE OR WHEN INDIVIDUAL SEIZURE EPISODE IS RESOLVING. e. Treatment of acute alcohol or sedative drug withdrawal may require doses at the higher end of the spectrum. f. Administration to agitated patients should proceed cautiously (titrate to desired effect). g. When titrating for procedural sedation, administer dose slowly, and observe for desired effect or complications before administering additional medication (titrate to effect). Administration for procedural sedation requires three lead ECG for cardiac monitoring, the administration of supplemental oxygen and ready availability of suction and airway adjuncts. h. Use the 5 mg per ml concentration. Apply half of the dose to each nostril. M07 Benzodiazepines Page 1

2 Appendix A: DIAZEPAM - Max dose = 50 mg total - 10 to 20 mg PO - 5 to 10 mg IM / IV - Max dose = 100 mg total - 10 mg PO - Repeat in 10 min as required - Max dose = 50 mg total ALCOHOL WITHDRAWAL (d) M07 Benzodiazepines Page 2

3 Appendix B: LORAZEPAM - 1 to 2 mg IM / IO / IV - Max dose = 4 mg total - 2 mg PO - 1 to 2 mg IM / IV - 1 mg PO - 1 to 2 mg IM / IO / IV - Repeat once in 2 min as required - Max dose = 4 mg total ALCOHOL WITHDRAWAL (d) - 1 mg PO mg/kg IM / IO / IV - Single max dose = 1 mg - Repeat once in 2 min as required M07 Benzodiazepines Page 3

4 Appendix C: MIDAZOLAM - 1 mg IM / IO / IV - Max dose = 10 mg total -0.5 to 1 mg IM / IO / IV to 5 mg IO / IV - 1 mg IM / IO / IV - Max dose = 10 mg total SEDATION OF INTUBATED PATIENT: to 5 mg IO / IV mg/kg IM / IO / IV - Single dose max = 1 mg - Max 5 doses to 0.2 mg/kg IO / IV to 1 mg IO / IV PROCEDURAL SEDATION (d): - 1 to 2 mg IO / IV M07 Benzodiazepines Page 4

5 Appendix D: INTRANASAL MIDAZOLAM (h) : : : Infant (0 up to 12 months): 1 mg 1 mg 0.1 mg/kg (single max dose = 1 mg) 0.1 mg/kg (single max dose = 1 mg) Repeat every 2 minutes as required Max 5 doses Max 3 doses M07 Benzodiazepines Page 5

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