Treatment for Opiate Overdose

[KEVD18]

0.4-2.0 q5min to a max of 10mg. but the minimum reccomended dose is 2mg.

iv/in/im/sc/et.

you can also do it as a taper at 0.4mg/hr but thats not really a pre hospital thing.

0.1mg/kg pedi max 0.8mg

 

[KEVD18]

the one department in ma thats field testing bls narcan is doing 2mg in(one in each nare) with an atomizer

 

[traumateam1]

0.4-2.0 q5min to a max of 10mg. but the minimum reccomended dose is 2mg.

iv/in/im/sc/et.

you can also do it as a taper at 0.4mg/hr but thats not really a pre hospital thing.

0.1mg/kg pedi max 0.8mg

I have co attended some OD calls with a medic who did administer Narcan. Both times it was 2.0mg, and each case they only did it once. But thanks for cleaing up what the doses were Kev, wasn't to sure what the max was.

Hmm.. wonder what would happen if you shot someone up with ~6mg iv first time. This is the crazy wild pt we are talking about?

 

[KEVD18]

well the drug has zero effects other than to force off the opiates and bind to the receptors. if you dont do narcotics, the drug will have no effects on you whatsoever. thats argument for giving it all at once.

the problem is that, if you are using opiates, a detox that rapid causes all sorts of bad juju. nausea, vomiting, diarrhea, fever, chills, tremors, tachycardia, aches and pains, elevated pain sensitivity, htn, suicidal ideation, depression, adrenal exhaustion, adrenal fatigue, delirium, a/v hallucinations, agitation, anxiety, panic disorder, paranoia, delusions are all likely symptoms.

 

[KEVD18]

oh, did i forget death, another possible side affect of rapid detox

 

[traumateam1]

Well that seriously sucks. Give me a few more months and I will be in EMT-A school and get back to you on that one.

 

[Sasha]

Slamming it all at once can and will send a narc addict into severe withdrawal from it. BAD for them, very bad.

Also, if you can achieve the desired effect with the minimum dosage, you shouldn't have extra stuff circulating.

Cowboy medics give us all a bad name.

 

[KEVD18]

why arent you out drinking?

 

[mycrofft]

Six years detox ward in the jail...

Anyone guess what drugs we used with great effect? (Not Narcan, but I'll tell you most were over the counter).
Nowadays if you blasted them with Narcan someone wuold complete the protocol to have you give them Methadone titrated to effect to revert them back to plan A, sorta.
I always had a hankering to try out two IV's (one with NS for the Narcan, the other for a glucose drip), a bedpan, trache tube, and cooling blanket. From high to dry in three minutes. Watch out, Betty Ford Clinic!

 

[remote_medic]

Anyone guess what drugs we used with great effect? (Not Narcan, but I'll tell you most were over the counter).
Nowadays if you blasted them with Narcan someone wuold complete the protocol to have you give them Methadone titrated to effect to revert them back to plan A, sorta.
I always had a hankering to try out two IV's (one with NS for the Narcan, the other for a glucose drip), a bedpan, trache tube, and cooling blanket. From high to dry in three minutes. Watch out, Betty Ford Clinic!

anyone else confused?

 

[Kendall]

Yeah, a little bit....

Narcan should be titrated to effect. Thats in the ALS protocols here... Why put yourself, your partner, and your patient at risk by pushing it all at once?

 

[Jon]

2 or .2? I say 2.. but everyone else is saying .2. Well good thing I don't have the protocol

Thats why we should be using leading zeros...

.2 looks like 2.
0.2 looks like 0.2... 02 don't make sense!

 

[Jon]

As for the initial question - if we JUST give enough to give them enough respritory drive that we don't tube them... it makes the ALS provider's life easy. We don't need to worry about an advanced airway... and we don't need to deal with a high drug addict that wants to refuse and/or fight us.

If you choose option B or C (tube them)... you are making your life difficult for no good reason... unless you haven't gotten a tube in a while

 

[Ridryder911]

Look how Narcan is packaged. It comes for adults as 0.4mg (vials) or 2mg vials (preload). Most use 0.4 mg IV; if effect noted then repeat to desired effect of increased respiratory rate and oxygenation effect.

R/r911

 

[Melbourne MICA]

Narcan for effect

We use 1.6-2.0mg IMI with concurrent BVM/100% O2. Extra 08.mg IM/IV if needed. BVM corrects the hypoxia, slow onset from IMI and correction of hypoxia means less chance of withdrawl type side effects ie pt wakes up nauseated, sweaty, tachy, agitated, feeling like crap and wants to take a swing at you. Takes a little longer but worth the wait.

It was one of the best changes to our guidelines ever. Old days BLS couldn't give Narcan (everybody can now) - MICA guys (who nearly always arrived after the BLS crews) didn't like pts waking before they set up a line and gave pushes of Narcan - result - lots of agitated pts.

Provided arrival time is short and pt hasn't been down too long (with maybe some EAR at scene with 911 phone assist) we get excellent results without incident. Pts wake up, sit and go - whoa, what happened? Beside 99% of the time pts don't want to go to hospital. Win win situation. You should rarely have to intubate unless it's a polypharmacy overdose.

MM

 

[vquintessence]

Ooops!

This is going on a tangent but figured it fits the conversation...

Everyone in here is talking about giving Narcan in doses titrated solely to increasing respiratory drive. Kudos and glad there weren't any sadists who want to give our frequent fliers withdrawals galore.

Anyway here's a scary story:

I have a coworker over here who is gung-ho when it comes to "doing things because he can". Well this guy went on a call where it was an obvious heroine OD. Everybody knows this pt and sure enough the fella shot himself too hot once again. Anyways so the pt has a little puke and whatnot and he's getting bagged s any problems.

Well it's Medic X's turn to lead for pt care... and the treatment option of choice? To give the pt a freakin IO to push 2mg. :glare: Yeah. Enough said. This guy has 10 plus years of "ALS experience" which makes it even the more scary. The ED flipped when they saw what happened. Medic X also got a slap on the wrist for the matter.

 

[Ridryder911]

Just to prove some systems never remove idiots.

R/r 911

 

[Outbac1]

If we need to bring them back for airway control we give 0.4mg IV. If they need more we give another 0.4mg. After that they're SOL as we only carry two amps. Usually we just manage their airway for them. If they're out of it they are no threat to me.

 

[medic258]

2mg IM. If that doesn't do it I will start a line and give 2mg more.

 

[boingo]

Skip the needle altogether and give it nasally. IO? Damn, thats just evil.