Versed IN verses IM

[RocketMedic]

I think a decent dose of midazolam im is a decent treatment.

 

[DPM]

Pt was actively seizing on arrival, am I right in thinking some of you would get the IV and go that way, over an immediate dose IN/IM?

 

[STXmedic]

I'll give an IM dose and then get the IV. Screw intranasal.

 

[DPM]

Not busting balls, but why do you feel that way about IN?

 

[STXmedic]

Variable, unreliable absorption. That, and it limits me to 2mg of versed. The only time I use the MAD is for fentanyl for pediatrics.

 

[DPM]

Ok, so you like being able to use the smaller dose so you have more left to work with? That's certainly a good point

 

[RocketMedic]

Not that, DPM. 2mg is generally an ineffective dose to resolve grand mal seizures. Coupled with unreliable adsorption, I have doubts as to the overall effectiveness of IN versed.

 

[DPM]

Ah ok. I can give a full 5mg for adults, IN. Would that make a difference in you choices? My county likes IN, so did my preceptor etc, and that's probably why I like it too. I've never really had trouble with it, but I am interested in what the brain trust has to say too.

 

[STXmedic]

Ah ok. I can give a full 5mg for adults, IN. Would that make a difference in you choices? My county likes IN, so did my preceptor etc, and that's probably why I like it too. I've never really had trouble with it, but I am interested in what the brain trust has to say too.

What is your concentration of versed?

 

[DPM]

5mg /ml

 

[STXmedic]

Ah, gotcha. And no, would still go IM.

 

[DPM]

My other issues is that IN is a double dose, so if that 5mg of my 6mg max doesn't work then I've only got 1mg left... Definitely going to give IM a go and see how I like that. (I've only used IM versed for sedation.)

 

[NomadicMedic]

5mg/1ml of Versed IN has (anecdotally) worked well for me.

However, 5mg/5ml is a pain in the butt to squirt up a snout.

 

[epipusher]

Love IN use for Versed admin. Used for seizures and chemical restraints.

 

[gotbeerz001]

I like IM if IV unavailable.

 

[Angel]

I have no problem doing any route. Max for adults here is 8 and peds is 4 in 1-2mg increments or 8 im or in based on weight

 

[Smitty213]

Since the debut of IN Narcan here, our Medical Directors have been poking around the idea of broadening the med's that can be given via that route. IN Versed was one that got rolled out this year; 5mg max, IV preferred, however IN if starting a line was "unsafe" to patient/provider. Haven't seen/done/heard of anyone I know here doing it that way, but it was a "highlighted change"...

 

[HotDrop89]

Variable, unreliable absorption. That, and it limits me to 2mg of versed. The only time I use the MAD is for fentanyl for pediatrics.

You don't like using nasal narcan?

 

[STXmedic]

You don't like using nasal narcan?

Not in the slightest. I'll take IM Narcan over IN any day.

 

[HotDrop89]

Not in the slightest. I'll take IM Narcan over IN any day.

Interesting...there's opiate overdoses every day where I'm from, it's become an epidemic. It's kind of sad because its a fairly small town, about 40,000 in the off season, over 100-120k in the summer. Anyways, nasal seems like the go to method even if the patient isn't breathing spontaneously. Or IV if you have one. What's your reasoning on this? Specifically with narcan? Curious to learn other providers thought process because nasal seems the least invasive, and it works VERY well most of the time