Nasal Narcan

[SubiEmt]

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.

I see, so maybe it is a tad bit different everywhere? Interesting stuff, thanks for the reply!

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.

Makes sense! So 2mg is the MAX dose we're looking at here. Would you ever give maybe half, then depending on the pt. status administer the rest? Or just make the call to give Xmg's up front and that's it? Thanks in advanced for the tips here.

 

[Medic Tim]

I see, so maybe it is a tad bit different everywhere? Interesting stuff, thanks for the reply!


Makes sense! So 2mg is the MAX dose we're looking at here. Would you ever give maybe half, then depending on the pt. status administer the rest? Or just make the call to give Xmg's up front and that's it? Thanks in advanced for the tips here.

The biggest issue with these types of things is education. The education of a Medic is not enough to cover all that we do. Yet they are giving basic providers Medic skills where the education is next to nothing.

If you are going to deviate or do something different from your standing orders you need to be able to back up what and why you did it. In my system we can treat our pts without forcing them into a black and white protocol. I do not know your qa/qi policies but I have heard that some areas treat their protocols as the bible so to speak and not following it to the letter will get you in trouble.

 

[Aidey]

Just for the record some types of opiates can require very large doses of narcan because the half life of the opiate is so much longer than that of narcan.

 

[NYMedic828]

Just for the record some types of opiates can require very large doses of narcan because the half life of the opiate is so much longer than that of narcan.

Or the efficacy is just massive in cases like fentanyl requiring 6-10mg of narcan.


To whoever called it a "nose plug thingy," its called a muscosal atomizer... Otherwise known as a MAD.

Your standard prefilled narcan IN kit has these parts.

 

[Devilz311]

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.

It's sad that I have experienced this multiple times... My last one was dispatched as an OD, about 30 seconds out we get an update from BLS on scene of CPR in progress. 20-ish y/o female with snoring respirations at about 4-6/min. I asked why they were performing CPR and I was told "well we hooked up the AED and it said no shock advised, start CPR... so we did." They were amazed when she miraculously came around to 0.4mg IV.

...And this particular individual is a CPR instructor... :huh:

 

[andyman0291]

ive used it more times than i can count... i work in one of the worst areas for heroin od's in the state.

 

[lsmft]

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.

What's your guys' max dose out there? Here if you give the 1mg/nare you'd need MCEP to authorize another 0.4 IV/SC. Hate to have them come out punching, which is why I like more controlled doses. Although I guess I'm going off the assumption your protocols are 1mg/nare as well.

 

[NomadicMedic]

Max dose is, "as much as you need".

I try to use as little as possible.

 

[zmedic]

I asked why they were performing CPR and I was told "well we hooked up the AED and it said no shock advised, start CPR... so we did." They were amazed when she miraculously came around to 0.4mg IV.

...And this particular individual is a CPR instructor... :huh:

You are going to be seeing more and more of this as the AHA moves away from pulse checks and towards just starting CPR for lack of signs of life.