Diazepam IM?

[redcrossemt]

Our protocols call for diazepam IV in the case of seizures. If IV access is not available, we can give rectally.

I had a patient this past week who was actively seizing upon our arrival, and had been for 20+ minutes. The patient had limited perhiperal IV access. I had no luck despite three attempts. I thought EJ access would be risky due to the way in which the patient was convulsing.

I was ready to go to our second route, of rectal administration. Unfortunately, the patient's anus was sewn shut.

I contacted med control and they ordered 10mg IM. I had been told before that diazepam causes necrosis and not to give it IM. It's not in our protocols either.

I'm wondering if IM diazepam is used regularly? Is it an acceptable route if IV/rectal routes are not available? I looked it up and most prescribing references do list IM as an administration route, so I assume it's common practice and someone just told me wrong.

 

[Aidey]

Where I previously worked we could give it IM, and where I work now we have the IM auto-injectors in the "oh 'crap' kit" (can't remember its real name, it's the bio attack kit).


Did the pt have a colostomy bag?

 

[Ditchmedic]

Our protocols call for IV also, but IM is OK if vascular access is unavailable. Do you also carry Versed? In a neighboring Medical Control, protocol is 5mg Versed IM, you are not to wait to establish an IV on an actively seizing patient.

 

[redcrossemt]

The patient did have a colostomy bag.

This was with a Southeastern Michigan drug box, so no versed.

 

[Smash]

Diazepam can be given IM however it is not partiucularly effective as it is not absorbed well and often forms sterile blebs in the muscle. Versed is a better choice as it is absorbed very well from the IM route, has a faster onset and shorter duration than diazepam. Of course if this isn't an option then I guess you have to try IM diazepam.

Also, contrary to what some people seem to think, benzodiazepines terminate seizures by inhibiting propogation of aberrant neuronal impulses in the brain, NOT by relaxing muscles.