Treatment for Opiate Overdose

How much narcan do you give?

  • A

    Votes: 40 88.9%

  • B

    Votes: 5 11.1%
  • Total voters
    45
KEVD18

KEVD18

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i have a purely hypothetical scenario:

you respond for the possible overdose. you arrive to find a patient(specifics are irrelevant) unconcious and responsive only to deep painful stimuli. you have evidence of narcotics use. needle tracks, bent spoons with soot on one side, empty paper 1x1 envelopes etc etc.

decreased resp rate, cyanosis, the works. im not going to bother to make up numbers(this really is hypothetical), but the bottom line is you need to give narcan.

do you:

a) administer enough of the drug to increase the resp rate(thereby increasing oxygenation) and start to bring the patient back around to the point that there v/s stabalize but hold back from brining them back to full conciousness

-or-

b) administer the maximum amount prescibed by your protocols as fast as you physically can deliver it and wait for the storm.
 
mea culpa. this should really be in scenarios. movement at the cl's discretion.
 
Option A is what we were taught but I honestly haven't dealt with an opioid OD patient yet in the field.
 
Option C --> Support resps with BVM if hemodynamically stable and let the ER deal with the narcan.


I know that option C is not right...but would be nice. Our protocols here in Maine guide us to give the minimal amount of Narcan for effect execpt in case of an arrest with suspician of narcotics.
 
I've learned that B leads to projectile vomiting like putting a finger over a loaded garden hose. No thanks.

A all the way.

(And I am a BLS provider, but basics in my area can push Narcan IN with IV certification.)
 
A) I'd rather not risk a combative patient because we ruined his $40 high.
 
As more and more research with the use of Narcan becomes available, why one need to give more than enough to increase respiratory effort and rate?

When one sees that it is "working" then one has determined the cause and can be titrated to effect. In all reality, that is all that needs to be done.

Why risks sudden withdrawal, combativeness, and dangers to the patient and EMS staff?

R/r 911
 
I have seen to many ODs come up swinging in the past. (I was still a basic, my medic partner decided to wake them up.) Giving just enough narcan to improve respirations is the only way to go.
 
Kev, I think you know my answer and my opinion on this issue :P (A)!!
 
fwiw guys, this topic came up in the chat room. everybody present was onboards with a with one dissenter(im guessing the same person who voted for b in this poll). i juts figured this topic could use the light of day. maybe, just maybe, it will help that provider improve their practice......
 
Just enough to improve the resp rate is fine for me.
 
Ridryder911 said:
As more and more research with the use of Narcan becomes available, why one need to give more than enough to increase respiratory effort and rate?

When one sees that it is "working" then one has determined the cause and can be titrated to effect. In all reality, that is all that needs to be done.

Why risks sudden withdrawal, combativeness, and dangers to the patient and EMS staff?

R/r 911
Click to expand...

Stole the words right out of my mouth.
 
ALS in the suburban system I work in have an unofficial protocol to push 0.2mg IM to bring back resps enough, load into the truck. En Route, they get O2, monitor, IV, etc going, then push the other 0.2mg just as they roll into the ER.
 
Epi-do said:
I have seen to many ODs come up swinging in the past. (I was still a basic, my medic partner decided to wake them up.) Giving just enough narcan to improve respirations is the only way to go.
Click to expand...

Why not just go ahead and wake them up? We always need a reason to justify the weapons we carry.
Just kidding push enough to bring respiratory rate up and let it go at that. No point in fighting or cleaning anymore than you have to.
 
KEVD18 said:
fwiw guys, this topic came up in the chat room. everybody present was onboards with a with one dissenter(im guessing the same person who voted for b in this poll). i juts figured this topic could use the light of day. maybe, just maybe, it will help that provider improve their practice......
Click to expand...

Didn't vote, swear to God.

Someone else is trying to be funny.
 
I also didn't vote. Didn't vote A or B because I don't have Narcan protocols.
 
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