NORTH COAST EMERGENCY MEDICAL SERVICES Policy #5333
POLICIES AND PROCEDURES
Subject : Medical Control
Rectal Administration of Diazepam
Associated Policies: 5332, 6516
I. Indications
Pediatric patient, age less that 12 years, who:
A. is actively seizing and has been seizing for more than ten (10) minutes; or
B. is actively seizing and has recurrent seizures, with no reawakening in between seizures; and
C. has had one (1) failed attempt at intravenous access or no vein is immediately apparent after close inspection.
II. Therapeutic Effects
A. Decreases cerebral irritability.
B. Relaxes skeletal muscle tissue.
C. Sedation.
III. Contraindications
A. Absolute -- Suspected or known allergy to diazepam.
B. Relative
1. Shock.
2. Trauma to rectum.
3. Congenital or surgical anomaly of the rectum.
IV. Adverse Effects
A. Respiratory depression or arrest may be caused or worsened by diazepam.
B. Drowsiness, vertigo, ataxia, transient hypotension.
C. Rectal injury may occur due to forceful entry of syringe.
D. Inadequate absorption, following rectal administration.
V. Equipment
A. 1-5 ml disposable syringe -- without needle.
B. Water-soluble lubricant.
C. 16 or 18 gauge needle (for drawing the medication).
VI. Procedure
A. Assure airway is open. Provide high-flow oxygen. Be prepared to support ventilation with appropriate airway.
B. Explain the procedure to the parent or care giver.
C. Place the patient in a lateral knee-chest position or supine with an assistant holding the legs apart.
D. Draw diazepam 0.5 mg/kg (maximum dose 20 mg) into a 1-5 ml syringe -- do not use a larger syringe.
E. Remove the needle from the syringe.
F. Lubricate syringe barrel with water soluble lubricant.
G. Gently insert the lubricated syringe into the rectum approximately 2-4 cm.
H. Instill the diazepam into the rectum.
I. Squeeze the buttocks together while removing the syringe to facilitate drug retention.
J. Document response and vital signs. Observe the patient carefully for respiratory depression and hypotension.