woman down

[STXmedic]

1-2 minutes typically. It's certainly not as quick as IV, but they also seem to come around slower (read: less vomiting).

Our dosing doesn't change with the route. Up to 2mg, repeated once, then calling for more. We don't typically titrate them to respirations, though. We "treat and street" a lot, though. Well, for heroin ODs that is...

 

[Akulahawk]

IIRC the protocols for naloxone that I was familiar with were basically 2mg, mr x1. The routes back then were either IV or IM and if we were to give it IV, we were to give it very slowly. I've almost always given naloxone by IV. I've given it once by IM. I believe an option we had/have was to divide the dose and give 1/2 by IM and the other 1/2 by very slow IV. It seemed to take a couple minutes for the patient to come around when I gave it IM. Apparently the absorption rate is quite a bit slower so the patients wake up less upset and have less vomiting. I suppose that in a way, it's a lot "nicer" to do than to give it IV.

Incidentally, I actually forgot about Vicodin as one of those "V" medications. I guess I could have asked what the pills in the bottles looked like...

 

[Angel]

i tried to describe how the vicodin looked using the keyboard but it probably wasnt very helpful. the only reason i knew it was vicodin off the bat was because ive seen the tabs like that before. the soma we were stumped till we got to the ER. even still, her symptoms with the labels etched off just seemed fishy.

 

[AcadianExplorer1910]

I'm bored so here's a scenario

It's the middle of a sunny afternoon and you are dispatched to a bus stop for an unresponsive female. as you and the engine pull up, you see bus security wave you in and hes pointing to the patient.

that's all you get for now.

scene safety, assess Pt., Vitals, hook up Pt. to monitor as well, 12 lead, ask Pt. SAMPLE; OPQRST, determine whether to transport unless patient refuses transport.

 

[medichopeful]

scene safety, assess Pt., Vitals, hook up Pt. to monitor as well, 12 lead, ask Pt. SAMPLE; OPQRST, determine whether to transport unless patient refuses transport.

Fairly certain an unresponsive patient won't be answering too many questions

Try thinking outside of the box a little bit, you'll be a much better provider!

 

[redundantbassist]

Fairly certain an unresponsive patient won't be answering too many questions

Try thinking outside of the box a little bit, you'll be a much better provider!

"MFR"

 

[medichopeful]

"MFR"

The title someone has shouldn't limit how they think if they want to progress!

 

[exodus]

"MFR"

MFR is equal to EMT over there.

 

[AcadianExplorer1910]

oh yeah sorry i forgot bout the unresponsiveness. doing the SAMPLE, OPQRST is a instinct yikes sorry

 

[Tigger]

We don't use IN Naloxone because (and I hate this) "we are too good for IN, so we aren't buying it." Sometimes egos get in the way. So she would have gotten 0.4mg IM. If that wasn't effective, she would have been intubated and that would have been that. Our previous medical director hated Naloxone for whatever reason, and any question of polypharm OD was to be intubated. So right or wrong, that's what would have happened here.

 

[EMT11KDL]

We don't use IN Naloxone because (and I hate this) "we are too good for IN, so we aren't buying it." Sometimes egos get in the way. So she would have gotten 0.4mg IM. If that wasn't effective, she would have been intubated and that would have been that. Our previous medical director hated Naloxone for whatever reason, and any question of polypharm OD was to be intubated. So right or wrong, that's what would have happened here.

that is how my old agency was, you dont come around with the first dose of narcan usually .8 with a splash, your gag reflex was checked if no gag intubated. if it was RSI and goodnight.

 

[AcadianExplorer1910]

The title someone has shouldn't limit how they think if they want to progress!

thanks all i know it takes me a while to learn but i love what i do and do what i love the most which is helping others. i have a instinct which needs to be worked on that when i see a unconscious patient i know they are unable to answer questions and refuse transport

 

[triemal04]

We don't use IN Naloxone because (and I hate this) "we are too good for IN, so we aren't buying it." Sometimes egos get in the way. So she would have gotten 0.4mg IM. If that wasn't effective, she would have been intubated and that would have been that. Our previous medical director hated Naloxone for whatever reason, and any question of polypharm OD was to be intubated. So right or wrong, that's what would have happened here.

Personally speaking, I don't see any major benefit, or need for the intranasal administration of drugs. (with the exception of pediatric sedation, I do see some benefits there)

The only things that would make it better than an IM injection would be the speed of onset, safety, and ease of use.

That I've seen it's certainly not a faster onset than an IM shot.

If the concern is for safety, either get safety needles (there are multiple different types and all are very cheap), or learn how to give an IM injection and how to safely handle a needle; even in a combative patient that you need to sedate the risk of a needle stick, when handled appropriately, is low.

And as far as ease of use, there's no difference if the patient isn't fighting, and if they are your option is either controlling a limb (doesn't need to be an arm) or the head, which, since you need to get it into the nostril, actually becomes more difficult.

Add in that a person with a lot of fluid in the nares or one who is snorting/exhaling forcefully through the nose will effect the absorption of the drug...yeah...why bother?

Certainly doesn't hurt to have it as an option, but for people who don't, no big deal.

 

[Tigger]

Personally speaking, I don't see any major benefit, or need for the intranasal administration of drugs. (with the exception of pediatric sedation, I do see some benefits there)

The only things that would make it better than an IM injection would be the speed of onset, safety, and ease of use.

That I've seen it's certainly not a faster onset than an IM shot.

If the concern is for safety, either get safety needles (there are multiple different types and all are very cheap), or learn how to give an IM injection and how to safely handle a needle; even in a combative patient that you need to sedate the risk of a needle stick, when handled appropriately, is low.

And as far as ease of use, there's no difference if the patient isn't fighting, and if they are your option is either controlling a limb (doesn't need to be an arm) or the head, which, since you need to get it into the nostril, actually becomes more difficult.

Add in that a person with a lot of fluid in the nares or one who is snorting/exhaling forcefully through the nose will effect the absorption of the drug...yeah...why bother?

Certainly doesn't hurt to have it as an option, but for people who don't, no big deal.

I agree that IN does not seem to have a lot utility in this case or others like it. However to think that "we can always get the IV or just give it IM" is poor reasoning when applied to all the medications that can be given in ways besides IV. Sometimes IN is appropriate, but we have chosen to not give ourselves that option based on shoddy reasoning.

I would like it for frontline pediatric pain management as well as for wilderness settings. I don't see much use for Naloxone with it.

 

[medichopeful]

thanks all i know it takes me a while to learn but i love what i do and do what i love the most which is helping others. i have a instinct which needs to be worked on that when i see a unconscious patient i know they are unable to answer questions and refuse transport

You're making the right steps towards being an excellent provider by coming on this website and getting involved! There's a lot to be learned here.

 

[Angel]

our protocol calls for 2mg off the bat for OD's. pt ended up with 4mg IN total, and that finally woke her up enough
(I may have said all this before)

 

[NomadicMedic]

So, I give Narcan IN every time and it always works (when it's indicated). In the last 5 years I can't recall I case when I've pushed it IV. It's easy, it's safe and effective. No brainier to me.

Te argument about "learn to give an IN correctly" doesn't hold water. Needle sticks happen, even with safety equipment, and the opportunity to totally eliminate that risk when dealing with a population that has a greater potential of being infectious is also a no brainier.

 

[triemal04]

While I do agree that IN is safer than an IM injection (it doesn't have a needle; kind of has to be) we're going to have to agree to disagree on if it's safer enough to really matter. Like it or not, there is something that needs to be said for the proper control, and care of sharps and how they are used; many people may be pretty blasé about them, but when used in an appropriate manner, even without a safety needle, the risk of a needle stick is very, very low. If that's the only reason for using the IN route versus the IM route it's certainly a valid reason...technically and in reality. I just personally don't think it matters that much.

Outside of isolated cases I don't see a lot of reason to be giving narcan IV either. IM for me baby!