Narcan doses with this last round of heroin/fent

[FiremanMike]

What dosage range are you guys/gals seeing for this latest round of heroin that's been cut with fentanyl?

Speaking for my immediate area, several incidents have been reported as requiring 6mg or more before any increase in respiratory effort can be appreciated. I'm just curious what you are all seeing and if there is any official literature out there on the topic yet?

Thanks

 

[Nova1300]

This may become a more common occurrence as Carfentanil starts to make its way into the street supply of opiates.

This is all conjecture on my part, but im guessing now that the cartels have figured out that synthetic opiates are cheaper and easier to produce than growing plants, we may need to start carrying a little more narcan.

 

[medicaltransient]

Igave 2 IN and 4 IV to the last guy we had no changes and performed RSI. His pupils were fixed at 4 I think we were treating anoxic brain injury. His HR was 150 after rsi and 5 of versed. This guy was snorting it.

 

[medicaltransient]

How long do yall wait after narcan before you intubate. I have seen it take a long time to work.

 

[NomadicMedic]

How long do yall wait after narcan before you intubate. I have seen it take a long time to work.

If I don't see some sort of spontaneous respiration in a couple of minutes, I'll intubate. I've actually only had that happen once though. If I'm relatively certain it is caused by an opiate, I'm happy to wait a few minutes before intubating.

 

[FiremanMike]

How long do yall wait after narcan before you intubate. I have seen it take a long time to work.

I don't personally have a hard and fast rule, but I typically avoid intubation on cases that I highly suspect as being opiate overdoses. I'll generally bag them to give the narcan plenty of time to work.. I would say that's the general mentality of most of the folks at my agency as well.

 

[Nova1300]

https://gma.yahoo.com/cincinnati-hi...es-2-days-110350323--abc-news-topstories.html

http://www.usatoday.com/story/news/nation-now/2016/08/25/supercharged-heroin-ohio-indiana/89306564/

Having to give multi-milligram doses of naloxone is not typical for reversal of fentanyl. I would be very aware of these ultra high-potency synthetic opiates such as carfentanil. I dont believe they are going away.