# Valium vs Versed for seizure



## Hockey (Aug 30, 2010)

Which (if Versed is available of course) one do you prefer for seizures, and why?

I've been noticing that Versed has been working a bit better than the Valium lately.

If you wish to post your local protocols on the issue, please do so


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## Smash (Aug 30, 2010)

Versed.  Shorter onset, shorter action, water soluble making it more versatile (IM, IV, IN, PO)


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## MrBrown (Aug 30, 2010)

Speak English not pharmacomarketing talk ... it's bloody *midazolam!*


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## Markhk (Aug 30, 2010)

Santa Clara County Adult Protocols

Status Seizure defined as continuous seizure lasting >5 minutes OR two or more seizures with incomplete recovery between each

- Check BGL - if <80 mg/dL use hypoglycemia protocol

- Midazolam 2 mg IV/IO, can repeat every 2 minutes, max 5mg , OR

- Midazolam 2.5mg per nostril IN , OR

- Midazolam 0.1 mg/kg IM, max 5mg 

We used to have diazepam but it was removed from the system in favor of midazolam.


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## Smash (Aug 30, 2010)

Markhk said:


> Santa Clara County Adult Protocols
> 
> Status Seizure defined as continuous seizure lasting >5 minutes OR two or more seizures with incomplete recovery between each
> 
> ...



Do you find those doses effective?  They seem rather conservative to me.


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## Medic50321 (Aug 30, 2010)

Very interesting topic.  I just had this patient.

Pt Hx - History of Seizures
Medications - Valium 4mg
Todays CC - 4 seizures in 15 minutes
Onscene - 2 more totaling 6 in 30 minutes.

Repeat dose of 4mg Valium IVB was noneffective, went with Medical Control for 2mg Versed which stopped the seizure and made patient AOx3 to get other information.


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## MrBrown (Aug 30, 2010)

We have (as with all medications) unlimited autonomous amounts and have IN, IM and IV midazolam.  If we give IN or IM midaz we cannot give an IV dose for a further ten minutes.  This change was because some Officers were giving an IM or IN dose then quickly gaining IV access and following the previous administration up with an IV dose.


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## Hockey (Aug 30, 2010)

Curious since we don't do anything IN, how do you do it with that?


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## Too Old To Work (Aug 30, 2010)

We use Ativan. Or for Mr.Brown Lorazepam. We don't even carry Valium any longer. We carry Versed, but that's for sedation, not seizures. 

So, my answer is "None of the above."


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## MasterIntubator (Aug 30, 2010)

MrBrown said:


> Speak English not pharmacomarketing talk ... it's bloody *midazolam!*



Eh.... maybe you should pull the string out there buddy.... 

Our protocols state when and how we use those 2.  Diazepam first line IV, Versed first line IN.  Follow up with the appropriate drug once an IV is established.


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## Aidey (Aug 30, 2010)

Versed for seizures, valium for muscle relaxation. Versed works for that too, but the valium isn't as sedating.


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## LondonMedic (Aug 31, 2010)

Lorazepam is, in my experience, the way forward. Quick acting, works well for seizure termination, reasonable duration of action, easily reversed.

Midazzle is okay, it's never really been first choice for seizures over here so I've used it less.


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## Akulahawk (Aug 31, 2010)

IIRC, midazolam replaced diazepam in Sacramento. I know that lorazepam is fast acting, but I've seen seizure patients continue to have break through seizure activity (physically) and had better results with diazepam. I personally wouldn't have any issue using any of those for controlling seizures (and I've given them all at some point in my career). Since Sacramento uses midazolam, that's what I'd have to use because it's what's available. It does work.


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## slb862 (Sep 2, 2010)

*First time seizures*

For first time seizure I prefer to use Ativan (lorazepam).  I would not use Versed on a first time seizure.  My opinion, Versed makes them forget, I want to know more when they come out of the seizure.  (I have long transport time).


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## MrBrown (Sep 2, 2010)

MasterIntubator said:


> Eh.... maybe you should pull the string out there buddy.... .



We use generic names for all our medications; Ventolin is salbutamol, Zofran is ondansetron, Epinephrine is adrenaline, Lasix is frusemide etc.

It's just so much easier than trying to remember the multiple names that a drug company markets thier products under.

Oh and frusemide is probably being withdrawn here next year anyway


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