Narcan (Naloxone) Training

[Don Quijote]

You might be in the wrong thread, dude.

Evidently. Let the echo chamber continue.

[1168]

Evidently. Let the echo chamber continue.

Its not an echo chamber, its a thread for professionals that use narcan and manage airway and respirations, and are interested in being good at it, and the ethics involved. Or laypeople and LEOs that want to help. Not judge, jury, and executioner.

Medics and clinicians jobs are not to decide who lives and dies, neither in civilian nor military medicine. It is to treat what we see. Dispatch will send us to the call. I’m sorry that you feel a smoker having a heart attack is somehow more deserving of my care. There’s a book titled “Medical Ethics for Dummies”. Give it a read, and lets get back on topic. I enjoy this thread and don’t want it locked.

[Hmac]

Either's he's in the wrong thread or we've passed over into trolling. I favor the latter.

[1168]

So, on topic, my agency is considering a change in protocol to the following:

Known or suspected opioid overdose, unresponsive:

Apneic: 4mg naloxone IN; manage airway and respirations as necessary.
Inadequate respirations: intubate, including administering drugs to facilitate that; no naloxone.
Adequate respirations: manage airway if necessary.

My personal tactic has been to use painful stimuli, adjuncts, and BVM, then naloxone (IV, as often as not), and intubate and place on ventilator only in failure of naloxone to restore respiratory drive, and need for airway protection. I’ve been very successful with this tactic, and it is in line with current protocol.

Opinions welcome, among providers.

[GTF425]

I prefer to do the same. Assess LOC, basic adjunct, and BVM. Depending on how involved the extrication is going to be will determine if I administer narcan on scene or, preferably, in the bus.

I prefer NPAs in the event a patient has an intact gag reflex or I have to progress to more advanced airways. If apneic, I prefer an iGel in the event they happen to regain consciousness and I need to remove it.

My basic approach to an OD is fairly simple:

1) Size up the patient, assess LOC
2) Palp a radial pulse, noting rhythm/quality and skin temp/condition. Count pulse for 6 seconds starting after I see their first full respiratory cycle. So long as they take one adequate breath during those 6 seconds, I'll add a 0 to the pulse count and call that good for a down and dirty baseline. (ie radial present, pulse tachy/brady/normal, respirations adequate)
3) O2 and simple adjunct. BVM if necessary, or NPA with NRB if they're breathing well on their own. NRB misting to count RR as a bonus.
4) Quick head to toe, looking for signs of trauma, drug paraphernalia (dope spoons, loose shoestrings in their pockets, track marks, bag of smack, pill blister packs, etc.)
4) Extricate.
5) Once in the truck, if we're bagging, I'll have my partner continue to bag while I take a full set of vitals, using the BP cuff as the TQ to start an IV, and spike a nag of NS.
6) Prep narcan. If RR is currently adequate, I'll just tuck the syringe behind my ear and keep it prepped. If I'm pushing narcan, I do it 0.1mg at a time with 5-10 seconds between slow IVP. It's been my experience that it takes significantly less narcan than I expected to support respirations, we just have to be patient.
7) Slap on a 3L and monitor the patient during transport.

If I have a transport > 10 minutes, it took more than 1.2mg to get them breathing, or a bystander tells me they blew something white, I'll prep a narcan drip.

A lot of variables, but basically:

NPA with BVM
Move to truck
Start IV, SLOWLY push narcan to support RR
Monitor for deterioration

I don't like advanced airways with ODs, I've had a patient rip a King out during transport and throw up all over me.

[1168]

I prefer to do the same. Assess LOC, basic adjunct, and BVM. Depending on how involved the extrication is going to be will determine if I administer narcan on scene or, preferably, in the bus.

I prefer NPAs in the event a patient has an intact gag reflex or I have to progress to more advanced airways. If apneic, I prefer an iGel in the event they happen to regain consciousness and I need to remove it.

My basic approach to an OD is fairly simple:

1) Size up the patient, assess LOC
2) Palp a radial pulse, noting rhythm/quality and skin temp/condition. Count pulse for 6 seconds starting after I see their first full respiratory cycle. So long as they take one adequate breath during those 6 seconds, I'll add a 0 to the pulse count and call that good for a down and dirty baseline. (ie radial present, pulse tachy/brady/normal, respirations adequate)
3) O2 and simple adjunct. BVM if necessary, or NPA with NRB if they're breathing well on their own. NRB misting to count RR as a bonus.
4) Quick head to toe, looking for signs of trauma, drug paraphernalia (dope spoons, loose shoestrings in their pockets, track marks, bag of smack, pill blister packs, etc.)
4) Extricate.
5) Once in the truck, if we're bagging, I'll have my partner continue to bag while I take a full set of vitals, using the BP cuff as the TQ to start an IV, and spike a nag of NS.
6) Prep narcan. If RR is currently adequate, I'll just tuck the syringe behind my ear and keep it prepped. If I'm pushing narcan, I do it 0.1mg at a time with 5-10 seconds between slow IVP. It's been my experience that it takes significantly less narcan than I expected to support respirations, we just have to be patient.
7) Slap on a 3L and monitor the patient during transport.

If I have a transport > 10 minutes, it took more than 1.2mg to get them breathing, or a bystander tells me they blew something white, I'll prep a narcan drip.

A lot of variables, but basically:

NPA with BVM
Move to truck
Start IV, SLOWLY push narcan to support RR
Monitor for deterioration

I don't like advanced airways with ODs, I've had a patient rip a King out during transport and throw up all over me.

Excellent technique, IMO. A few notes:

3) when I apply O2, I always use nasal capnography.

4) on a head to toe, it is a good practice to search for fentanyl patches

One technique for titrating IV naloxone slowly is to throw 2mg in a 250 bag and run it at a medium pace. You are correct that it commonly takes less than you might expect. I don’t always do it this way, but you are right when you say a little works if you are patient. I get good results usually from 0.5 to 1.0 mg. Bonus points if you co-administer zofran, and have suction ready.

I try hard to avoid advanced airways in these pts, assuming I can maintain reasonable SpO2 and EtCO2. It buys them a trip to the ICU, and increases risk of iatogenic problems. Every pt needs to be treated individually, regardless of how boring and routine they seem.

[Krazykarl]

Excellent technique, IMO. A few notes:

3) when I apply O2, I always use nasal capnography.

4) on a head to toe, it is a good practice to search for fentanyl patches

One technique for titrating IV naloxone slowly is to throw 2mg in a 250 bag and run it at a medium pace. You are correct that it commonly takes less than you might expect. I don’t always do it this way, but you are right when you say a little works if you are patient. I get good results usually from 0.5 to 1.0 mg. Bonus points if you co-administer zofran, and have suction ready.

I try hard to avoid advanced airways in these pts, assuming I can maintain reasonable SpO2 and EtCO2. It buys them a trip to the ICU, and increases risk of iatogenic problems. Every pt needs to be treated individually, regardless of how boring and routine they seem.

Good suggestion on item #3. Now that our cold weather is fast approaching, it is hard to get a reliable biox on a patient. Medical director wants o2 titrated to reach 94% saturation. Hard to do that in prehospital setting. As long as respirations are occuring either naturally or BVM, capnography will work regardless of cold poorly perfusing digits. At least until the patient pukes and clogs up the tubing.

[GTF425]

Excellent technique, IMO. A few notes:

3) when I apply O2, I always use nasal capnography.

4) on a head to toe, it is a good practice to search for fentanyl patches

One technique for titrating IV naloxone slowly is to throw 2mg in a 250 bag and run it at a medium pace. You are correct that it commonly takes less than you might expect. I don’t always do it this way, but you are right when you say a little works if you are patient. I get good results usually from 0.5 to 1.0 mg. Bonus points if you co-administer zofran, and have suction ready.

I try hard to avoid advanced airways in these pts, assuming I can maintain reasonable SpO2 and EtCO2. It buys them a trip to the ICU, and increases risk of iatogenic problems. Every pt needs to be treated individually, regardless of how boring and routine they seem.

Excellent point on fentanyl patches, as well as checking for any transdermal patch they may be wearing or insulin pumps.

And absolutely 100% on capnography. The agency I work for only has inline capnography, so I have to jerry rig it to work with a NC. I’ll be the first to admit that it’s been a while since I’ve last used it outside of an advanced airway in place.

[1168]

My agency is very generous with nasal capnography. The official stance is if I use it on everybody, we’ll just order more of them. I use it a lot.

[ST911]

We now return you to intelligent and thoughtful discussion of naloxone use in the field. Have a great day.