# Midazolam (Versed)

Seizure control and indication-specific sedation, with distinct adult and pediatric limits.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/midazolam/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- Be ready to assist ventilation and protect the airway if respiratory depression occurs.
- Adult seizure: contact base if activity continues for 5 minutes after the first IM dose or second IV/IN/IO dose (10 mg total by any route).

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=3)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [SO-M-040 — Seizure / Convulsions - Adult / Adolescent](https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-M-040%207-15-21.pdf)
- [SO-P-075 — Seizure / Convulsion - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-75%20Seizures%20peds.pdf)
- [SO-C-020 — Symptomatic Bradycardia - Adult/Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-C-20%20Bradycardia.pdf)
- [SO-M-030 — Psychiatric / Behavioral Emergencies](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-M-030%20Behavioral%2010-2025.pdf)
- [SO-M-080 — Sedation for Endotracheal or LMA Intubation - Adult / Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-M-80%20Sedation%20for%20ETT%20or%20LMA.pdf)
- [SO-P-120 — Pre-Existing Endotracheal Intubation Requiring Sedation - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-120%20Peds%20sedate%20existing%20ETT.pdf)
- [SO-P-070 — Psychiatric / Behavioral Emergencies - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/SO-P-070%20Peds%20Behavioral%2004-2026.pdf)

## Use in OCEMS

- Used in active/recurrent seizures and specific pacing, airway, and behavioral-emergency pathways.
- A seizure dose does not authorize all sedation uses. Select the condition order and its blood-pressure, repeat-dose, and base-contact rules.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Active seizure — preferred | 10 mg IM once, before attempting new IV/IO access. |
| Seizure — alternative | 5 mg IV/IN/IO if IM cannot be delivered or IV/IO already exists; may repeat once after about 3 minutes for ongoing/recurrent activity. |
| Pacing distress | When systolic BP is above 90: up to 5 mg IV slowly titrated. If IV cannot be obtained, 5 mg IN divided between nostrils; may repeat once after about 3 minutes. |
| Toxic delirium interfering with loading | SO-M-030: 5 mg IV, repeat once in 5 minutes if no improvement; OR 10 mg IM/IN once. For patients older than 65, consider 5 mg IM/IN, repeat once in 5 minutes if needed. |
| Specified airway sedation — I-15 / SO-M-080 | 5 mg IV/IO/IM once for the listed jaw-tone/airway-placement or pre-existing tube-tolerance indication when systolic BP is above 90. Follow the complete airway order. |

## Pediatric

- Seizure SO-P-075: 0.2 mg/kg IM once, maximum 10 mg. Alternative when IM cannot be given or IV/IO is already present: 0.1 mg/kg IN/IV/IO, maximum 5 mg; repeat once after 3 minutes for continued/recurrent seizures.
- Base contact is required for all pediatric seizure patients, whether transported or not; pediatric-capable base preferred.
- SO-P-070 toxic delirium interfering with loading: contact base (pediatric-capable preferred) for a possible 0.2 mg/kg IM/IN one-time order, maximum 10 mg. This is not an independent pediatric standing-order sedation dose.
- SO-P-120 pre-existing, correctly positioned ETT that is poorly tolerated: with systolic BP above 80, consider 0.1 mg/kg IV/IO/IM once, maximum 5 mg. Base contact is required. Reassess BP; if it falls below 80, give 20 mL/kg saline, maximum 250 mL, and reassess. Monitor oxygenation/ventilation and do not extubate after sedation under this pathway.
- I-20 marks pediatric cardioversion sedation as base-order treatment; use that specific order rather than another indication’s regimen.

## Pediatric weight table — Ongoing seizure — preferred IM route

- Source: SO-P-075. Dose rule: 0.2 mg/kg; route: IM once.
- 0.2 mg/kg IM once; maximum 10 mg. The IM first-line regimen is distinct from the lower alternate-route dose.
- Base contact is required for every pediatric seizure patient, including non-transported patients. Monitor ventilation and prepare BVM support.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IM once | Volume at 5 mg/mL |
| --- | --- | --- |
| 3 kg | 0.6 mg | 0.12 mL |
| 4 kg | 0.8 mg | 0.16 mL |
| 5 kg | 1 mg | 0.2 mL |
| 6 kg | 1.2 mg | 0.24 mL |
| 8 kg | 1.6 mg | 0.32 mL |
| 10 kg | 2 mg | 0.4 mL |
| 12 kg | 2.4 mg | 0.48 mL |
| 15 kg | 3 mg | 0.6 mL |
| 20 kg | 4 mg | 0.8 mL |
| 25 kg | 5 mg | 1 mL |
| 30 kg | 6 mg | 1.2 mL |
| 35 kg | 7 mg | 1.4 mL |
| 40 kg | 8 mg | 1.6 mL |
| 45 kg | 9 mg | 1.8 mL |
| 50 kg | 10 mg | 2 mL |
| 60 kg | 10 mg | 2 mL |

## Pediatric weight table — Ongoing seizure — alternate IN/IV/IO

- Source: SO-P-075. Dose rule: 0.1 mg/kg; route: IN/IV/IO.
- When IM cannot be delivered or IV/IO is already present: 0.1 mg/kg IN/IV/IO; maximum 5 mg per dose. May repeat once after 3 minutes for continued or recurrent seizure.
- Base contact is required for all pediatric seizure patients. This is not the 0.2 mg/kg IM first-line dose.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IN/IV/IO | Volume at 5 mg/mL |
| --- | --- | --- |
| 3 kg | 0.3 mg | 0.06 mL |
| 4 kg | 0.4 mg | 0.08 mL |
| 5 kg | 0.5 mg | 0.1 mL |
| 6 kg | 0.6 mg | 0.12 mL |
| 8 kg | 0.8 mg | 0.16 mL |
| 10 kg | 1 mg | 0.2 mL |
| 12 kg | 1.2 mg | 0.24 mL |
| 15 kg | 1.5 mg | 0.3 mL |
| 20 kg | 2 mg | 0.4 mL |
| 25 kg | 2.5 mg | 0.5 mL |
| 30 kg | 3 mg | 0.6 mL |
| 35 kg | 3.5 mg | 0.7 mL |
| 40 kg | 4 mg | 0.8 mL |
| 45 kg | 4.5 mg | 0.9 mL |
| 50 kg | 5 mg | 1 mL |
| 60 kg | 5 mg | 1 mL |

## Pediatric weight table — Toxic delirium interfering with loading

- Source: SO-P-070. Dose rule: 0.2 mg/kg; route: IM/IN once.
- Possible base-ordered dose: 0.2 mg/kg IM/IN once, maximum 10 mg, for the specific toxic-delirium/loading indication.
- Base contact and direction are required; a calculated dose does not create independent standing-order sedation authority.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IM/IN once | Volume at 5 mg/mL |
| --- | --- | --- |
| 3 kg | 0.6 mg | 0.12 mL |
| 4 kg | 0.8 mg | 0.16 mL |
| 5 kg | 1 mg | 0.2 mL |
| 6 kg | 1.2 mg | 0.24 mL |
| 8 kg | 1.6 mg | 0.32 mL |
| 10 kg | 2 mg | 0.4 mL |
| 12 kg | 2.4 mg | 0.48 mL |
| 15 kg | 3 mg | 0.6 mL |
| 20 kg | 4 mg | 0.8 mL |
| 25 kg | 5 mg | 1 mL |
| 30 kg | 6 mg | 1.2 mL |
| 35 kg | 7 mg | 1.4 mL |
| 40 kg | 8 mg | 1.6 mL |
| 45 kg | 9 mg | 1.8 mL |
| 50 kg | 10 mg | 2 mL |
| 60 kg | 10 mg | 2 mL |

## Pediatric weight table — Poorly tolerated pre-existing ETT

- Source: SO-P-120. Dose rule: 0.1 mg/kg; route: IV/IO/IM once.
- For a correctly positioned, pre-existing ETT that is poorly tolerated and systolic BP above 80: 0.1 mg/kg IV/IO/IM once; maximum 5 mg.
- Base contact is required. Monitor oxygenation, ventilation, and BP; follow SO-P-120 for hypotension and do not extubate after sedation under this pathway.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IO/IM once | Volume at 5 mg/mL |
| --- | --- | --- |
| 3 kg | 0.3 mg | 0.06 mL |
| 4 kg | 0.4 mg | 0.08 mL |
| 5 kg | 0.5 mg | 0.1 mL |
| 6 kg | 0.6 mg | 0.12 mL |
| 8 kg | 0.8 mg | 0.16 mL |
| 10 kg | 1 mg | 0.2 mL |
| 12 kg | 1.2 mg | 0.24 mL |
| 15 kg | 1.5 mg | 0.3 mL |
| 20 kg | 2 mg | 0.4 mL |
| 25 kg | 2.5 mg | 0.5 mL |
| 30 kg | 3 mg | 0.6 mL |
| 35 kg | 3.5 mg | 0.7 mL |
| 40 kg | 4 mg | 0.8 mL |
| 45 kg | 4.5 mg | 0.9 mL |
| 50 kg | 5 mg | 1 mL |
| 60 kg | 5 mg | 1 mL |

## Pediatric weight bands — cardioversion sedation

- I-20 pages 1–10: base hospital order required for cardioversion sedation; the chart lists IN/IV/IM and 5 mg/mL. Confirm the specific order and timing.
- Published band doses below are distinct from seizure and toxic-delirium regimens. Do not extrapolate outside the bands.
| I-20 weight band | Base-ordered dose | Concentration |
| --- | --- | --- |
| 3–5 kg | 0.4 mg | 5 mg/mL |
| 6–7 kg | 0.6 mg | 5 mg/mL |
| 8–9 kg | 0.8 mg | 5 mg/mL |
| 10–11 kg | 1 mg | 5 mg/mL |
| 12–14 kg | 1.2 mg | 5 mg/mL |
| 15–18 kg | 1.5 mg | 5 mg/mL |
| 19–23 kg | 2 mg | 5 mg/mL |
| 24–29 kg | 2.5 mg | 5 mg/mL |
| 30–36 kg | 3.5 mg | 5 mg/mL |
| 37–49 kg | 4.5 mg | 5 mg/mL |

## Preparation & reassessment

- Stock is 5 mg/mL; verify route, dose, indication, previous doses, and timing.
- Monitor oxygenation and ventilation. Seizure orders direct BVM assistance when ETCO₂ is 50 mmHg or more.
- I-15 and the full behavioral order differ in some repeat-dose details; this page uses the indication-specific SO-M-030 wording. For airway sedation, open the linked SO-M-080 / SO-P-120 rather than reusing another row.