Question: I'm wondering if IN Midazolam should be administered by full dose or until effect if effect is reached prior to the administration of the full dose? Does the answer change if given IV? For example, patient is in seizure so I administer 5mg Midazolam IN and seizure stops. Am I to continue and administer the remaining 5mg to a total dose of 10mg as per the directive, or do I stop?
The ACP Seizure Medical Directive outlines the dosing for Midazolam. It is our recommendation that this medication be administered as a bolus. If for some reason (dilution of meds or two separate syringes required to administer 10mg IN)) while administering the medication the patient stops seizing, the remaining amount of Midazolam does not have to be administered. The concern here would be further suppressing the airway responses in a post ictal patient when the end goal (cessation of seizure) has already been achieved.
You should remember to record your circumstances and reasoning for not giving the full dose on your ACR, as this delegated medical act under-dosage will create a flag which we will be able to close out by reading your clinical notes on the call.