Nasal Narcan

[NYMedic828]

I wonder what would happen if you injected it into the right nostril first, lol.

 

[eprex]

:rofl:

That gif is the best

 

[mycrofft]

I'd be more cautious with hep c with the injected drug crowd than HIV

Many many many of either "Crowd" has both hepatitis and HIV, along with other things like nasal colonization of staph bacteria, and increasingly STD's .

 

[mycrofft]

Quoting NYMedic828 re basics giving narcan by protocol:

"I certainly do not approve of the protocol due to the dosing. 1mg per nare is ridiculous. If we aren't capable of understand titration at a BLS level (emphasis added..mycrofft) and fully understanding what we are doing then we shouldn't be permitted to administer the medication at all.

Taking shortcuts by making it as simple as possible instead of providing the proper education is not acceptable in my book."

Maybe that is one case of why basics can't give much beyond sugar, oxygen and topical antiseptics in most areas. Titration is not taught, and is not as simple as giving X dose a number of times until sign Y appears.

Narcan is not mother's milk and any drug given by a practitioner demands that the indications and measures of/for Plan-B are taught in case the med doesn't work or makes things worse.

 

[NYMedic828]

Quoting NYMedic828 re basics giving narcan by protocol:

"I certainly do not approve of the protocol due to the dosing. 1mg per nare is ridiculous. If we aren't capable of understand titration at a BLS level (emphasis added..mycrofft) and fully understanding what we are doing then we shouldn't be permitted to administer the medication at all.

Taking shortcuts by making it as simple as possible instead of providing the proper education is not acceptable in my book."

Maybe that is one case of why basics can't give much beyond sugar, oxygen and topical antiseptics in most areas. Titration is not taught, and is not as simple as giving X dose a number of times until sign Y appears.

Narcan is not mother's milk and any drug given by a practitioner demands that the indications and measures of/for Plan-B are taught in case the med doesn't work or makes things worse.

Agree 100%.

These cases are where you start either drawing or erasing the line between BLS and ALS.

Either keep it as basic as possible, or teach what is necessary to appropriately perform the task in an educated manor. Taking shortcuts by making the procedure as brainless as possible is not acceptable.

It is shocking to me that a physician would even allow administration of a medication in an essentially careless manor.

 

[mycrofft]

MD's were prescribing Valium, Phenobarbitol, Talwin, THalidomide, and earlier yet, radium salts and laudanum with abandon before their drawbacks were fully appreciated.

Erasing the line: urban: yes, maybe. Rural and frontier: not unless a way is found to even approach the degree of EMS coverage they have now, which is piddlin' little in some areas (which also have no hospitals to speak of).

 

[NYMedic828]

I made a point on my county forum about my dislike of the dosing and this is what someone posted back...

"The IN dose is 1mg/nare (2mg total). With IN, not all of that is going to make it into the bloodstream. Some of it will run down the throat, some will run down the face, and some will just stick to nose hair."

 

[NomadicMedic]

Apparently people on your county forum are idiots?

 

[NYMedic828]

Apparently people on your county forum are idiots?

 

[mycrofft]

But a good point about the drawbacks of nasal introduction. What of the pt has rhinorreah, epistaxis? If it is atomized, nasal hair can be an obstacle. If the nasal solution is ingested, will it still work, or work the same?

SO many times I wish hypodermic introduction of meds was still pursued as it once was; if the technique is aseptic and the drug correct in selection, dose and route (IM versus sub q, versus intradermal, versus IV), then the drug is not only on its way, but various formulations (such as with penicillin) can make it a timed release so serial doses are not required.

 

[SubiEmt]

hi. I'm a new EMT Basic Starting with a company on tuesday. During the orientation the boss lady was talking about how nasal narcan is about to be accepted by my state. Im wondering if any of yall have ever used this and if so, how effective is it in comparison to injected narcan?

Seen the medics do it. Restrain your OD patents :rofl:

 

[Tigger]

Seen the medics do it. Restrain your OD patents :rofl:

For actually?

 

[NYMedic828]

If you have to restrain your overdosed patient you are improperly administering the drug.

If you know it's an opiate induced condition and respiratory status is sufficient and they are just knocked out, leave em be.

If used as a diagnostic tool or to restore respiratory status then titration to desired effect is key. Narcan takes very minimal doses and has a very rapid onset regardless of route. IV in my experience is near instant. IN/IM maybe 30-120 seconds. The goal should be to restore sufficient breathing and keep them relatively sedated if possible.

Keep in mind narcan only lasts around 30-60 minutes and morphine for example can last 2-4 hours. You must monitor the patient even if you think the condition is resolved because try can fall back into it easily in some cases.


It would behoove you to research how opioid receptors work and then you will understand narcan. Knowing all of the effects of narcotics can be very beneficial in ruling out a suspected overdose prior to medicating your patient. (Look up Mu,kappa,delta receptors)

 

[SubiEmt]

For actually?

No they didn't actually do it. I was joking only because most (including this particular pt.) did become combative. Awesome first had experience to see how fast the drug took effect! Pt reps were almost non existent, cynotic around the lips. Of course bagged him, medics administered the drug IN, and almost instant improvement. Really cool stuff.

 

[Handsome Robb]

No they didn't actually do it. I was joking only because most (including this particular pt.) did become combative. Awesome first had experience to see how fast the drug took effect! Pt reps were almost non existent, cynotic around the lips. Of course bagged him, medics administered the drug IN, and almost instant improvement. Really cool stuff.

Still sounds like they gave too much.

We can give IN near an but it's a pain in the *** since they are needled prefills, no leur-locks Everything else has them except the narcan...

 

[SubiEmt]

Still sounds like they gave too much.

We can give IN near an but it's a pain in the *** since they are needled prefills, no leur-locks Everything else has them except the narcan...

Hmm, next time I'll have to ask what the protocol is for dosage. Or I'm sure you can answer that for me? You said they were pre-filled? Sounds like there's maybe already a set dosage? Does the medication differ per county depending on where you work? Sorry for the 20 questions, but you have my attention now!

 

[nemedic]

At a service I used to work for in MA, they had IN Narcan in pre filled 2mg syringes with this little nose plug adapter. For basics, the requirement/training was 1mg up each nare.

 

[Medic Tim]

Hmm, next time I'll have to ask what the protocol is for dosage. Or I'm sure you can answer that for me? You said they were pre-filled? Sounds like there's maybe already a set dosage?

The key is titration. Just because it comes supplied at a certain concentration does not mean you have to give it all. If you protocol says 2 mg it does not mean give 2 mg to every overdose pt just because the protocol said so. There is no need to give the pt 2 mg when less than half of that will most likely work. Then again I work in a system that as long as we are in scope and doing something to benefit the pt we are good to go.

 

[NYMedic828]

Hmm, next time I'll have to ask what the protocol is for dosage. Or I'm sure you can answer that for me? You said they were pre-filled? Sounds like there's maybe already a set dosage? Does the medication differ per county depending on where you work? Sorry for the 20 questions, but you have my attention now!

Everywhere I have been, carries Prefilled 2ml bristojets at 1mg/ml. On rare occasion I have seen Prefilled syringes and closed vials.

This is one of those things where the protocol should be manipulated to suit your patient. Giving 1mg(half a vial of 1ml) per nostril is improper. It really only takes 0.2-4mg IV, 0.4-8mg IN/IM in my experience to achieve desired effect without creating an angry junky. IN/IM can have more sparatic absorption rates and impeding factors than IV so the dose varies more.

The dose is the same, or should be the same, everywhere you go. I've never seen narcan not come in a 1mg/1ml solution.

 

[Medic Tim]

Everywhere I have been, carries Prefilled 2ml bristojets at 1mg/ml. On rare occasion I have seen Prefilled syringes and closed vials.

This is one of those things where the protocol should be manipulated to suit your patient. Giving 1mg(half a vial of 1ml) per nostril is improper. It really only takes 0.2-4mg IV, 0.4-8mg IN/IM in my experience to achieve desired effect without creating an angry junky. IN/IM can have more sparatic absorption rates and impeding factors than IV so the dose varies more.

The dose is the same, or should be the same, everywhere you go. I've never seen narcan not come in a 1mg/1ml solution.

Agreed.



We use 0.4mg/ml amps.