Versed IN verses IM

[NomadicMedic]

I use IN Narcan every time. It works, every time.

Anecdotal? Sure. But, in my experience, why use a sharp when you can use a MAD?

 

[triemal04]

Interesting...there's opiate overdoses every day where I'm from, it's become an epidemic. It's kind of sad because its a fairly small town, about 40,000 in the off season, over 100-120k in the summer. Anyways, nasal seems like the go to method even if the patient isn't breathing spontaneously. Or IV if you have one. What's your reasoning on this? Specifically with narcan? Curious to learn other providers thought process because nasal seems the least invasive, and it works VERY well most of the time

What's your reasoning for using IN instead of IM or if you already have one IV?

Provider preference aside, there aren't that many reasons to choose one over the other. Anecdotatlly I've gotten quicker results using an IM injection with narcan and there are more times that I've seen than not that IN wouldn't work with versed, but other's have probably seen the opposite, and there likely isn't enough of a real difference in time to matter.

If it's a safety issue...meh...while IN might be technically safer than giving an IM injection, even if you don't have some form of safety needle (and if you don't they're very cheap and worth looking into) if you are that concerned about getting a needle stick from an IM shot...you need to work on your technique and process.

 

[HotDrop89]

Interesting...there's opiate overdoses every day where I'm from, it's become an epidemic. It's kind of sad because its a fairly small town, about 40,000 in the off season, over 100-120k in the summer. Anyways, nasal seems like the go to method even if the patient isn't breathing spontaneously. Or IV if you have one. What's your reasoning on this? Specifically with narcan? Curious to learn other providers thought process because nasal seems the least invasive, and it works VERY well most of the ti

What's your reasoning for using IN instead of IM or if you already have one IV?

Provider preference aside, there aren't that many reasons to choose one over the other. Anecdotatlly I've gotten quicker results using an IM injection with narcan and there are more times that I've seen than not that IN wouldn't work with versed, but other's have probably seen the opposite, and there likely isn't enough of a real difference in time to matter.

If it's a safety issue...meh...while IN might be technically safer than giving an IM injection, even if you don't have some form of safety needle (and if you don't they're very cheap and worth looking into) if you are that concerned about getting a needle stick from an IM shot...you need to work on your technique and process.

I wasn't talking about safety necessarily. I'm saying it's less invasive. If we're talking about safety, why bring out a sharp if you can quickly push 1mg in each nostril with an atomizer. Avoiding use of a needle doesn't mean you have bad technique if you can give the drug a different route that works just as well. Reminder I was asking about narcan not versed. Even though the thread is about versed lol my apologies. Thank you

 

[triemal04]

I wasn't talking about safety necessarily. I'm saying it's less invasive. If we're talking about safety, why bring out a sharp if you can quickly push 1mg in each nostril with an atomizer. Avoiding use of a needle doesn't mean you have bad technique if you can give the drug a different route that works just as well. Reminder I was asking about narcan not versed. Even though the thread is about versed lol my apologies. Thank you

My point is that, barring department mandates, it's really going to come down to provider preference. Your preference is to use IN because it's less invasive. You even mentioned that it works just as well as IM/IN...so...all about personal preference.

 

[HotDrop89]

My point is that, barring department mandates, it's really going to come down to provider preference. Your preference is to use IN because it's less invasive. You even mentioned that it works just as well as IM/IN...so...all about personal preference.

Fair enough! How effective has IM narcan been for you? Does it take significantly longer to get desired effect etc.

 

[STXmedic]

Interesting...there's opiate overdoses every day where I'm from, it's become an epidemic. It's kind of sad because its a fairly small town, about 40,000 in the off season, over 100-120k in the summer. Anyways, nasal seems like the go to method even if the patient isn't breathing spontaneously. Or IV if you have one. What's your reasoning on this? Specifically with narcan? Curious to learn other providers thought process because nasal seems the least invasive, and it works VERY well most of the time

I work in the inner city of a city with a population over 1mil. Heroin is seen daily (although synthetic marijuana laced with PCP has been the theme of the last month or two). Anecdotally, I've seen IN work in 30 seconds to not at all, and varying tremendously in between. When I give IM, I know that it'll start to kick in in about a minute nearly every time. If it takes longer, it's because we had to re-dose because it was a stronger batch or laced with fent. As to the safety of using needleless, just don't stab yourself...

 

[Chewy20]

just don't stab yourself...

 

[triemal04]

Fair enough! How effective has IM narcan been for you? Does it take significantly longer to get desired effect etc.

Very, it's all I use for probably 90% on my narcotic OD's. It does take longer than IV, and probably slightly longer than IN (though that hasn't been my experience), which really isn't a concern.

 

[Posterior]

Our protocol for Sz's is .2 mg/kg Versed IM. We no longer carry Valium. We are supposed to repeat the Versed until the Seizure stops. There was a case study that I am unable to locate citing that Versed is water soluble allowing it take affect quicker than other medications. From experience and the findings in the study, it takes approx 15 seconds to control and seizure.

 

[Carlos Danger]

Our protocol for Sz's is .2 mg/kg Versed IM. We no longer carry Valium. We are supposed to repeat the Versed until the Seizure stops. There was a case study that I am unable to locate citing that Versed is water soluble allowing it take affect quicker than other medications. From experience and the findings in the study, it takes approx 15 seconds to control and seizure.

What allows midazolam (and other fast-acting CNS drugs, like propofol and etomidate and fentanyl) to take effect quickly is its lipid solubility.....meaning it can cross the blood-brain barrier more easily than less lipid soluble meds.

Midazolam has a unique property that makes it interesting, though......it is water soluble in acidic solution, meaning it doesn't need to be mixed in a solution that makes it burn on injection, like propofol, etomidate, ativan, etc.....however, when exposed to physiologic pH, its imidazole ring opens and it becomes lipid soluble, hence it's rapid onset. Pretty cool.

 

[triemal04]

Our protocol for Sz's is .2 mg/kg Versed IM. We no longer carry Valium. We are supposed to repeat the Versed until the Seizure stops. There was a case study that I am unable to locate citing that Versed is water soluble allowing it take affect quicker than other medications. From experience and the findings in the study, it takes approx 15 seconds to control and seizure.

Did you really mean to say 0.2mg/kg? As a single dose? Because for someone my size you're talking about giving 18mg IM.

 

[chaz90]

Did you really mean to say 0.2mg/kg? As a single dose? Because for someone my size you're talking about giving 18mg IM.

We use that weight based dosage for peds, which always strikes me as funny since you get to the adult dose quite quickly. It specifies not to exceed the adult dose so it's no big deal, but it's always been interesting to me.

I could totally give you 18 mg IM in a single dose in a big muscle if I had a big vial of that 5 mg/mL concentration. Not saying it would be at all conducive to you maintaining any kind of spontaneous respiratory effort, but c'est la vie!

 

[triemal04]

It would certainly stop the seizure...

 

[Posterior]

Did you really mean to say 0.2mg/kg? As a single dose? Because for someone my size you're talking about giving 18mg IM.

Yes that's correct. That's whats the protocol reads. That's also the same for a combative patient. However, I rarely administer the full dose because like you implied, that's a lot in a single dose and I prefer to see how the medicine will react or a patient will respond. I seem to get the "wanted" effects at .1 mg/kg IM. As always, think outside the box, and the book is the box.

 

[cfd3091]

We had an attempted suicide yesterday. Unknown quantity of weed killer. He was alert and combative, did not want us or LEO anywhere near him. We finally got him in the rig and I was able to get the monitor on him (still struggling) two LEO's helping. Sinus tach 110 and 88% 02. Medic calls and gets approval for Versed IN up to 5mg. He gives him 2mg,1 in each. About 2 minutes later the cops let go and 1 minute later he tells us he now loves us and sleeps the whole way in. Put a NC at 2 lpm and drove in . I have never seen Versed IN work so well.

 

[samiam]

However, 5mg/5ml is a pain in the butt to squirt up a snout.

I read a study that there is no point to doing more then 1ml per nostril, it will not atomize correctly and not get absorbed. I will post the link if i come across it again.

We had an attempted suicide yesterday. Unknown quantity of weed killer.

He turn out ok? Round-Up does not appear to be that toxic interestingly.

 

[cfd3091]

He turn out ok? Round-Up does not appear to be that toxic interestingly.

Medically he seemed fine by the time we cleared. They were fixin' to move him to Behavioral when we brought another patient in about an hour later. It wasn't Round-up brand but it probably was chemically the same. Poison control was "0" help on the phone. Told us to be sure to keep his head up and airway clear. Well no ****, Thanks.

 

[NomadicMedic]

I read a study that there is no point to doing more then 1ml per nostril, it will not atomize correctly and not get absorbed. I will post the link if i come across it

Yes, that's why 5mg/5ml is a pain. You have to do it a ml at a time.

 

[samiam]

Yes, that's why 5mg/5ml is a pain. You have to do it a ml at a time.

Ah I gotcha, How long do you have to wait between doses?

 

[NomadicMedic]

Ah I gotcha, How long do you have to wait between doses?

I'd give a ml in each nare, wait a few and if needed, give a little more. I think the protocol says to wait 5 minutes.