NASAL NALOXONE

[tddubois]

It hasn't happened yet, but sometime in the next couple of weeks, the service I work for is going to be adding nasal narcan to its BLS trucks (it has been in testing at the ALS level, and reports have apparently been good). I wanted to see what people (both BLS and ALS) think about this, and to see if it is something that has gained acceptance in area's other than my own. I had never heard of it before our education department briefed us on the use of it.

Let me know if you have any questions on the protocol.

[Doczilla]

We just adopted it in our protocols. Looking at the studies, it has roughly equivalent onset of action as IM narcan. The chief advantages are that you won't risk introducing infection as you will with a needlestick, you don't have to wait to start an IV to get it on board, and you don't have a contaminated sharp on scene after administration. It's optional for our medics and EMTs. They can do IM narcan if the patient is somewhat awake and they are concerned about getting bitten while trying to give the IN spray.

We also use the spray for seizures, which is where this administration route really shines. Onset of action is quick, and you don't have to get the IV first on a moving target. It's standing order to give IN Versed on a seizing patient before attempting the IV.

Thus far the medics are very fond of the MAD and have anecdotally had great results.

'zilla

[Ridryder 911]

Narcan given inhaled route has been popular for a couple of decades now. Although, the "atomizer" is a newer approach. Great idea, for those you cannot get a line on..

R/r 911

[Spock]

We added IN narcan to our protocol using the MAD device about a year ago but it is utilized rarely. I'm not sure why our medics don't use it because we do get alot of OD's. Perhaps we are just not in the habit of using IN anything. IN versed for the seizing patient is a great idea but again we don't use it regularly. Some folks use IN versed for sedation but it burns quite a bit so I don't think it is practical for that purpose. I'm going to have to remember IN narcan for the next OD I see.

Live long and prosper.

Spock

[1EMT-P]

I like IN Narcan, but you have to be careful when you give it that you don't wake up an aggressive patient.

[Ridryder 911]

I prefer to give just enough Narcan to increase the respiratory drive.. so one has to remember if they are not inhaling ot will take a lot longer to work through mucosa membrane. The same is true that you have to be cautious of "suddenly awakening" your patient.

Again, many use Narcan for a broad spand of medications.. and questionable if appropiate or not. Personally, I feel what the heck.. if it works great!

Be safe,

R/r 911

[tddubois]

What other drugs are people pushing IN via a MAD?

[Dustdevil]

Minus 5 for posting an ALS topic in the BLS forum.

Yes, we know you are talking about EMT's, but pharmacology is ALS regardless of who is performing it.

[nsmedic393]

We just adopted IN Versed into our protocols for seizing patients, I haven't had a chance to try it yet though.

As for Narcan, our provincial medical director is not big on narcan being given any route. Except for unusual situations, we are only supposed to give narcan if we cant intubate the the patient and then we are only giving enough to bring back spontanious resps.

[tddubois]

Minus 5 for posting an ALS topic in the BLS forum.

Yes, we know you are talking about EMT's, but pharmacology is ALS regardless of who is performing it.

My apologies dust, I'm new to this forum.