Quote:
Originally Posted by
1168
Unless the ALS unit is greater than 15 minutes out, yes. And if you are giving Narcan, the objective should be to restore adequate respirations, not wake the patient. Keep in mind that the medic is going to have to deal with this guy after you cause vomiting and withdrawal. Follow your local protocols, of course, but I would rather First Responders not give any patients drugs of any sort, except oxygen, epi, glucose, or aspirin as appropriate.
The majority of opioid OD’s I attend have adequate respirations and reasonable SpO2, ETCO2, etc. They are just somnolent. Which is not really an overdose, so much as the target effect for the junkie, but whatever.
Actually, lemme rephrase that: Many of the “OD’s” I attend are not opioid overdoses at all. Your area may differ.
Yes, the objective is to restore breathing. Waking them up for us is essentially a side effect.
Quote:
Scope EMR, EMT
Class Narcotic Antagonist
Action Competes with opiates for receptor sites in the brain that affect pain and breathing,
thereby reversing the respiratory and CNS depressant effects of opiate drugs.
Onset IN 3-5 minutes
Peak Effect 20 minutes
Duration 1- 2 hours
Indications Suspected opiate intoxication (pinpoint pupils, decreased respiratory rate, drug
paraphernalia) with depressed mental status AND apnea or slow shallow breathing.
Contraindications Infants less then 28 days old, Known allergy to naloxone
Side Effects Causes opiate withdrawal in patients with opioid addiction/chronic exposure (anxiety,
agitation, piloerection, body aches, diarrhea, diaphoresis, yawning)
Rare - Pulmonary edema, acute myocardial infarction, ventricular arrhythmias
Form Ampule: Various sizes: 1mg, 2mg, 10mg
Preload: 2mg in 2ml
Dosage See Mucosal Atomizer Device (MAD) Procedure for administration of IN dosing
> 10-Adults: IN: 2mg every 5 minutes prn ALOC (max 10mg)
< 10 yrs: IN: 0.1mg/kg (max 2mg per dose) every 5 minutes (max 10 mg)
Notes If 10mg of naloxone is given and there is no response, then ALOC is unlikely due to
opiates (Other considerations- hypoglycemia, head injury, hypothermia, hypoxia,
shock, stroke)
Pinpoint pupils are the classic sign of narcotic use/overdose, but with multi-drug
intoxications, pupil findings may be variable.
Naloxone has NO side effects in the absence of opiates or opiate addiction. It is
remarkably safe, so do not hesitate to use if indicated.
Naloxone has a shorter duration than many opiates, so observe closely for re-sedation
and repeat doses as necessary. Also, important to strongly discourage patients who
attempt to sign out against medical advice as life threatening symptoms may return as
naloxone wears off.
Some agents (e.g. Fentanyl) may require higher than usual doses for reversal.
For paramedics (we are almost exclusively EMTs; the only medic curently at my duty location is the EMS coordinator):
Quote:
Scope Paramedic
Class Narcotic Antagonist
Action Competes with narcotics for opiate receptor sites in the brain that affect pain and
breathing, thereby reversing the respiratory depressant effects of narcotic drugs.
Onset IV/IO: 2 minutes
IN/IM: 5 minutes
Duration 1- 4 hours
Indications Suspected narcotic intoxication with altered mental status AND apnea or slow shallow
breathing.
Contraindications None
Side Effects Acute withdrawal syndrome in patients addicted to opiates (pain, nausea, vomiting,
diarrhea, hypertension, tachycardia, tremors).
Form Ampule: Various sizes: 1mg, 2mg, 10mg
Preload: 2mg in 2ml
Dosage IN Route preferred
> 10-Adults: IN/IM: 2mg every 5 minutes prn ALOC (max 10mg)
IV/IO: 2mg every 2 minutes prn ALOC (max 10mg)
< 10 yrs: IN/IM: 0.1mg/kg (max 2mg per dose) every 5 minutes (max 10 mg)
IV/IO: 0.1mg/kg (max 2mg per dose) every 2 minutes (max 10 mg)
Notes Pinpoint pupils are the classic sign of narcotic use/overdose, but with multi-drug
intoxications, pupil findings may be variable.
Naloxone has no side effects in the absence of narcotics. It is remarkably safe, so do not
hesitate to use if indicated.
Naloxone has a shorter duration of action than many narcotics, so observe closely for re-
sedation. Repeat doses may be necessary.
Some agents (e.g. Darvon, Fentanyl) may require higher than usual doses for reversal.