Midazolam vs Diazepam

[fakingpatience]

My agency only carries valium, can give 5mg, then a second 5mg, have to call for any additional dosages ... This area isn't so big onto the whole "progressive" thing (also only morphine for pain, no other narcotics). So far I haven't been impressed with the valium's ability to control seizures.

[Vorenus]

My agency only carries valium, can give 5mg, then a second 5mg, have to call for any additional dosages ... This area isn't so big onto the whole "progressive" thing (also only morphine for pain, no other narcotics). So far I haven't been impressed with the valium's ability to control seizures.

That might have been the case, because 5mg is a pretty low start dosis for someone who ways more than 15 kg.

[Bernhard]

For rectal applied sedation/seizure control we have only Diazepam (5mg and 10mg tube), if not choosing an antipyretic (because fever may often be the cause for pediatric seizures). However, if I can establish i.v. access soon I prefer Phenytoin for seizure control. Midazolam is in our toolbox, too, but I did never use it for seizures as far as I remember - even in times we had no Phenytoin I rather used Diazepam.

It's a known fact that Diazepam stays longer than Midazolam, so the study seems like old news, or do I overlook something? Midazolam has a faster impact on breathing depression, so I'm a bit reserved in using it if airway control may be tricky (rule of thumb: it always is...). Having a longer sedated patient is not my main concern in the prehospital setting, having issues with airway control because of fast or too much sedation is.

Be aware that epilepsy patients may have a high tolerance for benzos, I sometimes used 50mg and more (once we used up around 80mg which was all we had on a 50kg woman and still couldn't break her seizures, still breathing and all). Phenytoin always did the work better and I'm glad we have it in the kit since some years now.