Nasal Narcan? What else?

[Odorono]

I'm trying to implement intranasal medication administration as an option in my area, and am looking for some additional research. I've found the Denver and Australia studies using IN naloxone, but have yet to find anything in the prehospital arena for other drugs (especially midazolam but also glucagon and fentanyl).

Anecdotally, how have those of you who do use it currently found its efficacy, and which meds are approved?

Most importantly, does anyone know of any services in New York State (air or ground) that currently use IN as a treatment modality?

[tskstorm]

I'm trying to implement intranasal medication administration as an option in my area, and am looking for some additional research. I've found the Denver and Australia studies using IN naloxone, but have yet to find anything in the prehospital arena for other drugs (especially midazolam but also glucagon and fentanyl).

Anecdotally, how have those of you who do use it currently found its efficacy, and which meds are approved?

Most importantly, does anyone know of any services in New York State (air or ground) that currently use IN as a treatment modality?

Use it in NYC ...

ALTERED MENTAL STATUS

1. Begin Basic Life Support Altered Mental Status procedures.

2. Begin an IV infusion of Normal Saline (0.9% NS) to keep vein open, or Saline Lock.

3. Administer Dextrose 25 gm (50 ml of a 50% solution), IV/Saline Lock bolus.

NOTE: A GLUCOMETER (IF AVAILABLE) MAY BE USED TO DOCUMENT BLOOD GLUCOSE LEVEL PRIOR TO DEXTROSE ADMINISTRATION.

IF THE GLUCOMETER READING IS ABOVE 120 mg/dl, DEXTROSE MAY BE WITHHELD.

4. Administer Thiamine 100 mg, IV/Saline Lock bolus.

5. In patients with diabetic histories where an IV/Saline Lock route is unavailable, administer Glucagon 1 mg, IM. (Thiamine need not be administered to these patients).

6. If there is no change in mental status, administer Naloxone up to 2 mg, IV/Saline Lock bolus. If IV/Saline Lock access has not been established, administer Naloxone up to 2 mg, IM or IN.

NOTE: IF AN OVERDOSE IS STRONGLY SUSPECTED, ADMINISTER NALOXONE PRIOR TO DEXTROSE AND THIAMINE.

7. If there still is no change in mental status or it fails to improve significantly, repeat Dextrose 25 gm (50 ml of a 50% solution), IV/Saline Lock bolus.

8. If there still is no change in the patient's mental status or it fails to improve significantly, repeat Naloxone up to 2 mg, IV/Saline Lock bolus. If IV/Saline Lock access has not been established, administer Naloxone up to 2 mg, IM or IN.

9. If there is still no change in mental status, contact Medical Control for implementation of one or more of the following MEDICAL CONTROL OPTIONS:

MEDICAL CONTROL OPTIONS:

OPTION A: Repeat Naloxone, up to 2 mg, IV/Saline Lock bolus (IM or IN if IV/Saline Lock access has not been established), up to 3 additional doses. (Maximum total dosage is 10 mg.)

OPTION B: Transportation Decision.

[scott33]

Someone has been studying for their NYC MAC :wink:

[Odorono]

Awesome. I've spoken prior with several down-staters but they were unaware of this. I read the remainder of the protocols; do you know why narcan was the only drug approved for IN?

Have the medics been using this option?

[tskstorm]

Awesome. I've spoken prior with several down-staters but they were unaware of this. I read the remainder of the protocols; do you know why narcan was the only drug approved for IN?

Have the medics been using this option?

I have not seen any medics use it.

I am unfamiliar with why IN Narcan was approved.

Some of my class instructors are on the Remac board (our protocol board) I will address it with them when I see them, most likely not till Thursday.

I am guilty as charged Scott I'm a medic student.

[fiznat]

We have it OK'ed by our medical control and actually have the atomizers in stock. We're not able to actually use the stuff yet though because our current Naloxone concentration is too low. Right now we have the 0.4 mg/ml stuff, which according to the nasal atomizer guys is way too dilute to be spraying in the nose. "It'll just run down the back of their throat," they said if I remember right.

IntraNasal Versed is coming down the pike as well for seizures in the absence of an IV.

[Dungan362]

We have access to atomizers but we don't use them very much! The only time I have used them I found that the narcan ran down the back of the throat. It didn't seem to work very well... at least not as well IM of course!!

[Reddfrogg]

in my service, in western CO, we can give Narcan IN, and Fentanyl IN. I've given Fentanyl IN, when I the patient refused to let anyone touch her before she got some pain medication (dislocated shoulder). After the IN Fentanyl, she allowed us to get an IV, and she got the second dose of Fentanyl IV.

[Medic26]

We have had it in our service here for about 3-4 years. It's been done a few times with Versed but none that I know of for Narcan or Fentanyl yet. I have not heard any complaints from anyone that has done any of the IN administrations. Some of this reason could be that we have been going down the path of airway management for narcotic overdoses and not giving Narcan unless the patient is hypOtensive as well. I like this because now the medical residents in the ER and the nurses have to do all the wrestling instead of us. :wink:

[tskstorm]

There is a GOP update I just saw today midazolam will also be offered IN ...