Nasal Narcan

[medservguru88]

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?

 

[rwik123]

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?

Yeah I have. It's fairly comparable to IV push....most often more convenient too if you don't already have a line. You can always give the initial dose IN, then switch over to IV once established. Not sure on the actual times of effect and resp drive return, but I know there close.

It also reduces the incidence of needle sticks in a generally assumed high risk HIV population.

 

[NomadicMedic]

Use it all the time. It rocks.

 

[STXmedic]

Use it all the time. It rocks.

This.

 

[medservguru88]

Yeah I have. It's fairly comparable to IV push....most often more convenient too if you don't already have a line. You can always give the initial dose IN, then switch over to IV once established. Not sure on the actual times of effect and resp drive return, but I know there close.

It also reduces the incidence of needle sticks in a generally assumed high risk HIV population.

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

 

[TransportJockey]

Our basics here have had it for a while, in addition to SQ/IM Narcan... I like it, but don't like that a lot of our basics give 1mg per nare... I don't want to wake up the druggie, just get them breathing.

 

[Tigger]

Our basics here have had it for a while, in addition to SQ/IM Narcan... I like it, but don't like that a lot of our basics give 1mg per nare... I don't want to wake up the druggie, just get them breathing.

That is unfortunately the way my company is instructing basics to administer it. I have no interest in giving the full 2mg as a first line dose, hopefully some leeway is possible.

 

[NYMedic828]

Our protocols are

IV 0.4mg increments titrated to 2mg.

IM/IN 0.8mg titrated to 2mg.


I find that 0.2mg IV and 0.4mg IN/IM is often plenty.

 

[sirengirl]

I find that 0.2mg IV and 0.4mg IN/IM is often plenty.

I watched an ER doc assume care for an OD patient that a rescue brought in. When asked why the medic did not give narcan, the medic said,

"Her RR is fine, pulse normal, color good, she's responsive to sternal rub... I didn't want to wake her up, she's good."

Doc then proceeds to give 0.2mg narcan IVP.... patient starts to rouse, grumbling and swatting at nothing. Doc then says,

"Push the other half."

ER medic and I spent the next hour pinning her to the bed as she thrashed, screamed, and flailed, while they force-inserted a Foley, and then she proceeded to use her feet to pull the Foley out, still fully inflated.

Good times. :glare: I will never go to that hospital.

 

[TransportJockey]

I watched an ER doc assume care for an OD patient that a rescue brought in. When asked why the medic did not give narcan, the medic said,

"Her RR is fine, pulse normal, color good, she's responsive to sternal rub... I didn't want to wake her up, she's good."

Doc then proceeds to give 0.2mg narcan IVP.... patient starts to rouse, grumbling and swatting at nothing. Doc then says,

"Push the other half."

ER medic and I spent the next hour pinning her to the bed as she thrashed, screamed, and flailed, while they force-inserted a Foley, and then she proceeded to use her feet to pull the Foley out, still fully inflated.

Good times. :glare: I will never go to that hospital.

I've worked ER as a tech and seen that. And it's why I make hospital sign for the patient before I let them pull crap like that.

 

[NomadicMedic]

I was dispatched on a cardiac arrest the other day. The EMT that arrived before me was freaking out, screaming that he needed my LUCAS. I sent him out to my truck to get it. By the time he came back, i had squirted a mg up the guys nose and he was sitting up.



IN Narcan is a medics best friend.

 

[NYMedic828]

I was dispatched on a cardiac arrest the other day. The EMT that arrived before me was freaking out, screaming that he needed my LUCAS. I sent him out to my truck to get it. By the time he came back, i had squirted a mg up the guys nose and he was sitting up.



IN Narcan is a medics best friend.

Should of said to the EMT, "So I guess we aren't going that initial assessment thing anymore?"

 

[NomadicMedic]

Should of said to the EMT, "So I guess we aren't going that initial assessment thing anymore?"

My sarcasm isn't typically appreciated by the BLS providers here.

 

[Remeber343]

My sarcasm isn't typically appreciated by the BLS providers here.

Eh, I figure the good ones shouldn't care and it should motivate the bad ones to get their act together..

 

[JPINFV]

I was dispatched on a cardiac arrest the other day. The EMT that arrived before me was freaking out, screaming that he needed my LUCAS. I sent him out to my truck to get it. By the time he came back, i had squirted a mg up the guys nose and he was sitting up.



IN Narcan is a medics best friend.

 

[the_negro_puppy]

We have no choice but to give 1.6,g I.M, however our protocols are flexible in that they prefer we do this only after ensuring adequate oxygenation / ventilation first.

Having said that, narc overdoses are very rare here. We do not have a huge heroin scene in my city, nor is prescription drug abuse as rampant as in the U.S. I have had one narc overdose in nearly 3 years. Bystander was doing CPR when we arrived, she was apeoeic however still had a tachy pulse, apparently IV oxycodone.

1 minute of ventilation with BVM and she came up swinging lol.

 

[Sandog]

Having said that, narc overdoses are very rare here. We do not have a huge heroin scene in my city, nor is prescription drug abuse as rampant as in the U.S. I have had one narc overdose in nearly 3 years. Bystander was doing CPR when we arrived, she was apeoeic however still had a tachy pulse, apparently IV oxycodone.

1 minute of ventilation with BVM and she came up swinging lol.

I wonder why this is so. I mean what are you guys doing right? Why is it that the U.S. can not follow?

 

[the_negro_puppy]

I wonder why this is so. I mean what are you guys doing right? Why is it that the U.S. can not follow?

I can't answer that. I can say that the population of Aus is around 22 million, and the U.S 300 million. Statistically you guys have a higher rate of drug abuse and given your geographic location and huge demand for drugs its no surprise that they flood the cities of the U.S

Heroin is scarce here because there is not a huge demand and we are quite geographically separated from Afghanistan etc. If I were a trafficker I would probably aim for the U.S as a market rather than Aus.

As per prescription drugs I guess it comes down to culture. Docs aren't as lenient in prescribing opiates/opioids here but then again your health system is much more privatised- when people are paying large amounts to see physicians they probably feel pressured to prescribe things. In a sense your health system is more commercial and "customer" focused.

Although Australia and the U.S are very very similar it seems the U.S is more extreme with its problems such as gang violence, crime and drug addiction. I'm 100% sure that if we had 10 times the population I would see far more opioid overdoses.

 

[NYMedic828]

Well, there goes the neighborhood. This just out by my county (not NYC)


Suspected Opioid Overdose Protocol for BLS Providers AAREMS, Monroe Livingston, Mountain Lakes, REMO, Suffolk and Nassau

Patient must have suspected narcotic overdose AND respiratory depression. Naloxone is not given to rule out opiate use.

I. Perform initial assessment. If ventilatory status is inadequate (patient is cyanotic, altered mental status, respiratory rate less than 10) support respirations according to Respiratory/Arrest Failure protocol.

II. Check blood glucose (BG must be greater than 65)

III. Determine potential for narcotic overdose (at least one of the following) a. History of overdose from bystanders
b. Paraphernalia consistent with opiate/narcotic use
c. Medical history consistent with opiate/narcotic use
d. Respiratory depression with pinpoint pupils
IF I, II and III are true THEN proceed with NALOXONE as follows:

IV. Open sealed NALOXONE container and remove one unit dose of Naloxone a. Examine for appropriate labeling, expiration and appearance
b. Attach mucosal atomizer device (MAD) to the syringe
V. Insert MAD into LEFT nostril and inject HALF the medication Repeat into the RIGHT nostril

VI. Continue to support ventilation as appropriate while initiating transport to closest appropriate Facility

VII. Document vital signs every 5 minutes

VIII. If patient's respiratory rate does not increase to greater than 10 within 10 minutes of initial Naloxone administration, repeat with second unit dose of Naloxone
Relative Exclusion Criteria: (Medical Control Option)
Cardiopulmonary Arrest
Recent seizure activity either by report or signs of recent seizure activity (oral trauma,
urinary incontinence) Pediatric patients
Opiate use for therapeutic purposes prescribed by a physician Evidence of nasal trauma, nasal obstruction and/or epistaxis

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 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.

 

[Aidey]

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