Versed dosing for RSI

[Aidey]

If Versed is in your RSI protocol, what dose are you using?

 

[Tigger]

Not sure if you mean for post-procedure sedation or as a replacement for etomidate, both are in the protocols though the latter is rarely if ever used.

For sedation 2mg over 2 minutes for patients 13-55yo, max of 4mgs. If used with fentanyl the dose is halved.

If etomidate is not available Versed can be given at 0.1 mg/kg prior to giving succinylcholine.

 

[Aidey]

If etomidate isn't available is there a max dose?

 

[Tigger]

I believe that is the maximum dose.

 

[Christopher]

I believe that is the maximum dose.

We have the 1-2-3 rule in effect for RSI dosing:

0.1 mg/kg Midazolam
2 mg/kg Succinylcholine
0.3 mg/kg Etomidate

Also in our local 1-2-3 rule is 1 mg/kg Rocuronium (I don't know why they didn't do 1.2) and 2 mg/kg Ketamine (although we don't have it).

 

[blindsideflank]

0.1mg/kg some say to a max of 5mg

Maintenance 0.05mg/kg ( and I time it prn)

 

[lightsandsirens5]

I've got it for PIM. Up to 5mg. Though I miss my Ativan. I like that stuff much better for...well, everything.

Not sure why I would ever need to use Versed as an "induction" agent as I have both Etomidate and Ketamine at my disposal for that. 0.3mg/kg and 1.5mg/kg, respectively.

 

[Carlos Danger]

0.1mg/kg some say to a max of 5mg

I've got it for PIM. Up to 5mg. Though I miss my Ativan. I like that stuff much better for...well, everything.

This is why I hate seeing versed used for induction....people rarely give doses that even begin to approach adequate. 5 mg isn't even close to the amount of versed needed to induce anesthesia in a decent sized (80 kg+) adult. I couldn't even imagine giving 5mg of versed to a conscious person and then pushing a NMB.

0.2 - 0.35 mg/kg is a much more appropriate dose range, IMO.

 

[Christopher]

This is why I hate seeing versed used for induction....people rarely give doses that even begin to approach adequate. 5 mg isn't even close to the amount of versed needed to induce anesthesia in a decent sized (80 kg+) adult. I couldn't even imagine giving 5mg of versed to a conscious person and then pushing a NMB.

0.2 - 0.35 mg/kg is a much more appropriate dose range, IMO.

Yeah, the lack of a max seems to be our systems' way of saying, "you'll need a lot". Although I haven't heard of a time where it was used for induction pre-hospitally.

 

[EMT B]

The flight surgeon on my pedi trauma the other day used 2mg versed 50mg fentanyl to induce

 

[NomadicMedic]

The flight surgeon on my pedi trauma the other day used 2mg versed 50mg fentanyl to induce

How big was the kid?

 

[EMT B]

about 21kg i transported to the LZ so he hadn't gotten any pain meds on board yet

 

[VFlutter]

We use 2-4mg of versed for moderate sedation during cardiac Caths. I can't imagine trying to RSI someone with 5mg.

 

[Carlos Danger]

about 21kg i transported to the LZ so he hadn't gotten any pain meds on board yet

That works out to about .1 mg/kg which seems inadequate to me (though the 2 mcg/kg of fentanyl certainly would have helped some), but it's still a much better dose than 5 mg for a 100 kg patient, which works out to about half what this kid got, per kg.

 

[EMT B]

what do you think he should have gotten? maybe thats not all he got, maybe he got more in the chopper?

thats still a decent amt. thats like giving a 105kg pt 10mg....

 

[Christopher]

what do you think he should have gotten? maybe thats not all he got, maybe he got more in the chopper?

thats still a decent amt. thats like giving a 105kg pt 10mg....

0.1 mg/kg - 0.3 mg/kg is the textbook range for induction, although >0.1 mg/kg produces moderate hypotension (~20% drop in SBP). However, the lower dose may produce less than adequate sedation.

I seem to remember a paper (but cannot find it) which noted that ED's routinely gave 0.05 mg/kg midazolam for induction due to mistaking the conscious sedation dose for the induction dose!

 

[NomadicMedic]

0.2ng/kg of versed is our sedation dose for peds, and 0.3mg/kg of etomidate for pedi RSI. I haven't had to RSI a kid, and hope I don't have to. Curious why the doc chose to use versed over etomidate or ketamine.

 

[blindsideflank]

We aren't talking versed only are we?

Versed and opiates have a synergistic effect so that 4 of versed used for cath is different. I've given 30 of morphine for gall stones (I don't believe the biliary spasm) and the person is still conscious but I guarantee if I added 2 of versed he would be out.

 

[EMT B]

0.2ng/kg of versed is our sedation dose for peds, and 0.3mg/kg of etomidate for pedi RSI. I haven't had to RSI a kid, and hope I don't have to. Curious why the doc chose to use versed over etomidate or ketamine.

not sure..im just a scrub emt ^_^

 

[FiremanMike]

I really dislike versed for induction or even pre induction, there are so many better options. My order of preference is ketamine then etomidate, each has their ups and downs and times when one is better than the other. For paralyzing I prefer 0.6mg/kg of roc over succs, but either will do. For post intubation I like to alternate 2-2.5 of versed and 50 of fent, seems to work well to keep the patient snowed enough to not remember but awake enough to breath on their own. Of course if you don't have a vent with SIMV, then vec post intubation seems like a better choice.