Field medications · Adult & pediatric guidance · ALS
Midazolam (Versed)
Seizure control and indication-specific sedation, with distinct adult and pediatric limits.
OCEMS source summary · Updated 2026-09-16
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).
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.
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
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
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.