In a seizing patient, midazolam can be given in __ mg increments, to a max dose of __ mg, IN/IV by standing orders

• A. 2 mg increments; 12 mg max
• B. 5 mg increments; 20 mg max
• C. 10 mg increments; 40 mg max
• D. 1 mg increments; 5 mg max

Answer: (B)

Midazolam is used to stop seizures and is given in careful, stepwise doses so you can quickly control the seizure without oversedating the patient. In this protocol, dosing in 5 mg increments allows rapid up-titration if seizures persist, while keeping the total dose within a safe ceiling of 20 mg. This balance helps achieve seizure control promptly via intranasal or intravenous routes, while reducing the risk of respiratory depression and other sedation-related complications. Standing orders enable immediate treatment by EMS providers without needing immediate physician contact, but you must still monitor the patient closely and be ready to manage the airway if deeper sedation occurs. Smaller increments could delay control, and larger increments or a lower max could increase the risk of oversedation or inadequate seizure management.