Versed Only

[stcommodore]

So my high volume urban ems service is removing valium come 12/1 and moving to Versed only for seizures. My medical director actually provided me the research for the choice. Anybody in similar circumstances?

[fireflymedic]

I'm much preferable to versed to valium for seizures. I have found patients that have frequent seizures to seem to develop tolerance much more quickly to valium than versed and also versed provides a longer coverage time than valium does. Also, you have the benefit of being able to go nasal via MAD with versed as well as IM and IV. All of which make it a very marketable drug for this use. Ativan though is also a good option, however it has a quite limited shelf life if you choose not to refrigerate it. Hope this works well for your service. Also - I'm definitely preferable to versed for premedication for cardioversion and also RSI. Valium just doesn't seem to do the job adequately and I've had patients that express having significant memory of procedures with valium only.

[P_Instructor]

Our service moved from Diazepam to Midazolam 10 years ago. Versed was much more versatile for our program. Long before nasal, Versed given IM (for status seizure and no IV) absorbs much quicker than Valium. The only initial problems associated with Versed useage were a couple of cases of underdosing for seizure. This problem was readily identified and corrected. It has work very well for us. Good luck, I think you will be pleased with it.

[Kiwiology]

midazolam is freaking wonderful stuff you'll love it, and so will your patients!

[WolfmanHarris]

We've been midazolam only for quite awhile.

I would love to see the research posted though.

[Arctickat]

Our province switched to midazolam a couple of years ago with the intention of removing diazepam and haldol. Then some wise guy came along and informed the powers that be that versed is not indicated for treatment of seizures. Now we have to also carry Ativan. Then, it was determined that anyone who has received diazepam while in hospital must be continued on diazepam rather than switched to another benzo, so now we still have Valium, but are supposed to use Versed for sedation and Ativan for seizures.

Commodore, if you can pass along that research, I'd love to get my hands on it so we can lose the Ativan.

[croaker260]

I'm much preferable to versed to valium for seizures. I have found patients that have frequent seizures to seem to develop tolerance much more quickly to valium than versed and also versed provides a longer coverage time than valium does. Also, you have the benefit of being able to go nasal via MAD with versed as well as IM and IV. All of which make it a very marketable drug for this use. Ativan though is also a good option, however it has a quite limited shelf life if you choose not to refrigerate it. Hope this works well for your service. Also - I'm definitely preferable to versed for premedication for cardioversion and also RSI. Valium just doesn't seem to do the job adequately and I've had patients that express having significant memory of procedures with valium only.

I actually have had opposite results. Both the pharmacology, and my personal experience, have had poorer "coverage" or duration of versed verses Valium in SZ control. In terms of actual initial SZ termination, I would say that they are comparable. Also I agree that given IM or IN, versed is indeed more versatile. Also, Versed has a bit more homodynamic trend toward hypotension as well, in my experience.

We carried Ativan a short period (18 months) about 5 years ago, and IMHO, it performed abysmally compared to valium, even though the pharmacology says it should work better. Yes, we swapped it out every 2 weeks, so that added cost as well. Finally, after reviewing multiple charts and complaints about the drug, We went back to Valium.

Here is our SZ control protocol: http://www.adaweb.net/Portals/0/Paramedics/documents/m06.pdf

Here i our pain control and sedation protocol: http://www.adaweb.net/LinkClick.aspx?fileticket=40oCwEva7XE%3d&tabid=798

Edited November 26, 2009 by croaker260

[paramedicmike]

Places I work, or have worked, haven't carried valium in years. It's been mostly Versed that we've used/carried. At one point we did try Ativan with similar results to what Croaker posted.

-be safe

[HellsBells]

Also, Versed has a bit more homodynamic trend

...Versed is sooo Gay.

Anyway, Versed is the only benzo we carry in Calgary. It seems to work just fine for seizures, and of course we use it for RSI, and sedation as well. It really seems that many systems in this neck of the woods are going away from valium use. However, I would love to see Ativan SL tabs in our service to settle some agitated pts.

...Oh and one more point about Versed, we currently have a Paramedic student from Nova Scotia who says the only drug they use in their RSS protocol is Versed, no analgesic at all.

[CBEMT]

We had Versed and Valium, then they took the Valium away. Now we're getting it back, with an option for Ativan if anybody's willing to refrigerate it (fat chance around here).

Who knows.