Narcan

[LucidResq]

So after my IV approval class I'll be able to give narcan nasally.

So tell me about it. What are your experiences with it? What special considerations need to be taken?

I know what it is, how it works, the indications and all that stuff. I'm more curious about how often it's used, any problems with administration, etc. I'd like experience-based info relevant to EMS, not the basics like dosage, actions, adverse reactions.

I've also heard that after you give it many people get REALLY pissed off. Should restraints be considered prior to administration of narcan?

 

[Emt /b/]

Here we are able to give 2mg intra nasally as basics. I haven't gotten to do it yet, though, seeing as I am a white cloud. The reason some people tend to be upset or agitated isn't because you are ruining their high, but because they wake up to see a bunch of people standing/crowding around them.

 

[Ridryder911]

Over abused medication in EMS. Very few to rarely should if ever given. In reality only should be given to opioid type overdoses, and then in limited amounts to prevent rapid detox and seizures. One only needs to raise LOC to maintain airway, not awaken them.

I have seen horrible experiences from idiot medics that caused vomiting and violent episodes.

Personally, should be eliminated except per Paramedic protocols and then scrutinized when used.

R/r 911

 

[eggshen]

Rarely will your run of the mill Heroin OD come unhinged after Narcan administration, rarely do they withdrawl. The folks you need to keep your eye out for are the Methadone users, or CA pts that have been dropping MS for the last nine years. These folks WILL go utterly bannanas every time. I have a feeling that is related to consistant levels and quality, just a theory. Restraints are a good idea if you happen to get dumb and wake them up all the way, try to shoot for a decent ventilatory rate, not converstion. Titrate.

Egg

 

[johnrsemt]

bag, not wake

I would rather bag a pt who has a decreased respiratory drive due to OD, than to risk them waking up and kicking the *@#! out of me; or to put them into seizures.
or as our medical director says: we know how to start IV's and push drugs, (IN narcan starts this year, now it is just IV). Intubate them, we need the practice.

 

[MSDeltaFlt]

Odds are, if they are suppressed, they will likely have something else in their system other than opioids keeping them suppressed so narcan will not likely work. I've been a medic for over 10 years and have given it only once, and only because I knew the pt and the history. 2mg didn't even touch him. It took 12mg.

 

[eggshen]

One time in 10 years? Wow!! I could not begin to count the times I have given Narcan. Must be a drag not dealing with junkies everynight.

As far as tubing them? I guess we could tube all the unc/unresp hypoglycemics as well eh?

Egg

 

[KEVD18]

anybody else get a chuckle from the fact that the op needed to take an IV class to be able to get NASAL narcan? just made me chuckle

 

[MSDeltaFlt]

In my area, they usually have taken so many other things that suppress them, that narcan won't usually work. And, with the enormous population of noncompliant seizure pts in my area, if you give them romazicon, the ER docs will pull your med control so fast it'll make your head spin.

That's why I love flying. I have more autonomy.

 

[eggshen]

Oh yea, as far as them waking up and roughing you up, I am not sure what type of Heroin you lot see out there but not once have I had a Heroin OD get feisty after waking them up. More often than not they some around nicely and proceed to deny Heroin use. Like I said, it's the chronic pain therapy folks that one needs to be cautious with. They go over the falls every time.

Egg

 

[eggshen]

Well MS, we are lucky 'round here, most seem to like one thing or the other. You get the speedballer here and there, which turns out to be fun, but that is no where near the norm, You can keep the saladbar to yourself, sounds a bit like work to me.

Egg

 

[MedicDoug]

One advantage that we see with Narcan IN vs. IV is that since the absorption rate is slower in the nose than in the vein, the spectacular adverse effects of Narcan administration are lessened. Also, there's no sharps issue, which is a good thing. The disadvantage is that with the IN route the response to the medication seems even more unpredictable, and it's virtually impossible to titrate to effect.

 

[triemal04]

Oh yea, as far as them waking up and roughing you up, I am not sure what type of Heroin you lot see out there but not once have I had a Heroin OD get feisty after waking them up. More often than not they some around nicely and proceed to deny Heroin use. Like I said, it's the chronic pain therapy folks that one needs to be cautious with. They go over the falls every time.

Egg

So I guess you really have never seen someone on a speedball, just heard about them. There is no point in slamming 2mg of Narcan to someone who doesn't need it; get enough into their system so that they can maintain their own airway and leave it at that.

 

[fma08]

three words, "titrate to effect" effect being pt is able to breath and maintain their airway on their own. GIVE ABSOLUTE MINIMUM TO ACHIEVE THIS!!! drug users get really irked when you destroy their $200 high. On the other end, you don't want to block out effects of opiates that are being used for chronic pain control like in terminal cancer patients. just enough so they can breath, don't need to take the pain relief away too.

 

[Ridryder911]

That is why I for abolishing pre-load dosages of 2mg Narcan. Let's go back to the 0.4mf vials so titrating to effect will be more prominent. Like I described, a lot of EMS Doc's are yanking it off the tricks because Medics are not using it appropriately.

R/r 911

 

[eggshen]

If you nail a speedballer with narcan of course they will fight. Not talking about that am I. At no point did I, or would I, advocate "waking" them up either.

Egg

 

[BossyCow]

If you nail a speedballer with narcan of course they will fight. Not talking about that am I. At no point did I, or would I, advocate "waking" them up either.

Egg

Our protocols are to place the pt in restraints prior to administering the narcan