Page 331 - ATP-P 11th Ed

Side-effects:
• Respiratory: laryngospasm, bronchospasm, wheezing, shallow respirations
• Cardiovascular: bradycardia, tachycardia
• Gastrointestinal: vomiting
• CNS/neuromuscular: retrograde amnesia, hallucination, confusion
• Special senses: blurred vision, diplopia, nystagmus, pinpoint pupils
• Hypersensitivity: anaphylactoid reactions, hives, rash, pruritus
• Miscellaneous: yawning, lethargy, chills, weakness
K9 Dose: 0.3mg/kg plus 5mg/kg ketamine IV (for sedation) 0.3mg/kg IV (for seizures)
Contraindications:
• Known sensitivity to midazolam
• Acute narrow angle glaucoma
• Injectable midazolam should not be administered to adult or pediatric patients in shock
or coma, or in acute alcohol intoxication with depression of vital signs
• Concurrent use of protease inhibitors (anti-HIV)
Pregnancy Category D
• Warnings: SECTION 3
° Use with caution when other medications capable of producing central nervous sys-
tem depression are used.
° Prior to the intravenous administration of midazolam be sure that the immediate
availability of oxygen, resuscitative drugs, age and size-appropriate equipment for
bag/valve/mask ventilation and intubation, and skilled personnel for the maintenance
of a patent airway and support of ventilation are available.
° Monitor patients continuously for early signs of hypoventilation, airway obstruction,
or apnea.
° Use with caution in patients with severe fluid or electrolyte disturbances.
° Oxygen is desirable, but not absolutely required.
Overdose treatment:
• Flumazenil may be used to reverse the effects of midazolam after accidental over-
administration. Flumazenil should not be used to reverse midazolam after seizure treat-
ment since this may result in intractable seizures. It should also not be used in the setting
of an intentional or mixed drug overdose.
• Monitor vital signs during the recovery period.
TMEP use:
• Acute Behavioral Changes Protocol
• K9 Trauma Management Protocol
• K9 RDX (C-4) Ingestion Protocol
• Seizures Protocol
• TCCC/TTP

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