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In this video, our paramedic will discuss the administration of buccal midazolam for the treatment of a seizure.  Seeing this video does not allow you to administer or manage this drug, it is purely so that you understand this valuable treatment that is used in rare cases. If you need further training, please contact us.

So what we are going to have a look at now is Buccal midazolam. Buccal midazolam is a drug that is regularly used in the care industry for people who have seizures. It is a very, very effective drug. We are going to have a look at how it is actually delivered in the different forms it comes, the different doses it comes, and actually how it is administered. So if we look at firstly the pre-filled syringes, you will notice on the outside of the syringe colour coded, so you have got orange, purple, blue and yellow. You have also got the age, okay? Less than 18 years, less than 10 years, less than five years and less than one year. Each will be prescribed specifically for your patient, so you should not have to work out the dosage unless you are a healthcare professional with that role. Normally, the patient will be prescribed a dosage set for them. That will change obviously as they get older, but the dosage is prescribed for the person. It is a little bit like an EpiPen, basically. They prescribe with an EpiPen with the dose that is required for their anaphylaxis and this is the same.

Now, the important thing is, on the outside of these tubes will be a dose, will be age and will also be a date, a date stamp. We need to make sure this is the correct patient, the correct dose, the correct date. In other words, the drug is in date. Because if it is not, we are going to have a catastrophe if we are not careful. This needs to be checked and double-checked. And really, the rule of thumb is, before you administer a drug, you check, you get somebody else to confirm before administration. Remember, once you have administered, you cannot take it back, so check it first.

The next thing that we have to be careful of is the seal. If the seal is broken on any medication, any medication, it should never be used. If this seal is broken, I do not know what drug is in this. That is important. Check the seal. If the seal is intact, the drug is the right age group, the right drug, the right name, then we can open up the drug itself. We take the top cap off, breaking the seal. We take out the syringe and in that syringe, there is the dosage that is required for our patient. It is pre-filled and on the end is a little stopper just to keep it safe inside its container. We take the stopper off and we now have a drug that is ready for administration. Note No needle. There should never ever be a needle on the end of a midazolam drug syringe. It does not get inserted via the needle, it goes into the buccal mucosa or in the mouth.

So where are we talking about? We are not talking in the mouth itself, we are talking about between the gum, the outer gum and the cheek itself. So what we do is we lift the cheek away from the gum. And remember, we are putting this into a patient who is potentially going through a heavy fit. We never put anything in the mouth, we never put our finger in the mouth. We go between the teeth and the actual gum itself and pull the gum away from the teeth like so. And we are then going to insert the syringe into the buccal area of the mouth and squeeze the drug in nice and gently into the mucous membrane. Once it is inserted in there, it is okay to rub it around, allow it to absorb through the mucous membranes in the mouth. And the patient should very quickly start to feel the effects of the drug itself, and the fit should gradually ebb away and fade away.

So remember, date, dosage, patient's name is all correct with the patient you are giving this. And the seal is intact actually on the tube itself. Inserted, removed, disposed of and then it is put into the drug book so we know what time the patient had the drug, how much drug they had. Time it and document it.

It also comes in a liquid form. This is if we are going to draw up a set dose for a patient. So if we are in a healthcare setting where my patient has a set dose of midazolam for their situation and we do not buy it in the process, syringes, we can draw it up. Again, we have a bottle with a date stamp on, with the concentration of the drug itself. So again, check, double-check and get someone to cross-check if you possibly can. They have a safety lid on the top to stop anybody tampering with it. So compress it, take the top off and you will notice there is a bong in the top of the bottle. That bong is there for a reason. It is there so that the little pipettes that draw the drug up, slide into and lock into position. We then shake the drug up to make sure it is all mixed properly, invert the bottle and draw the dose that we require onto the syringe itself, drawing it back until we get the required amount. And notice there is a mark on the syringe stem to give us the actual dilutions.

Once we have got the correct amount, we take it back off, put the lid back on the bottle to keep it clean and safe. And repeat exactly the same, pulling the gum and the cheek apart, sliding it in between the gum and the cheek into the buccal mucosa and depressing the plunger, forcing the drug actually into the mucous membrane around the teeth. Note again, there is no needle and there is nowhere for you to put a needle on this particular one. So needles are not required for buccal.