Nasal Narcan? What else?

[firedoc315]

[/font:13f4af816c]my agency, in the Pacific Northwest, has been using IN Fentanyl, Versed, and Narcan for a year with zero, none, zilch problems. The issue with any medication "running down the back of the throat" occurred with the first three or four administrations; and was corrected by increasing the speed of emptying the syringe. Onset is equal to or on occasion seems to be faster than IV, particularly if you calculate the time to establish an IV. There is more reluctance by one segment of responders to use IN because some folks believe it is ok to "punish" opioid abusers; me - no blood, no needles, no risk! !! !!! Works for me, after 35 years in EMS

There have not been any "failed" administrations either.

We have been unable to find any literature support for IN Glucagon, so we are not using it.

[akroeze]

We can give Naloxone and Midazolam IN.

I ONLY give IN midaz for active seizures.... I'm not exposing myself to potential sharp stick by starting an IV on a seizing patient when I have safer options.

Any time I have used it it has worked quite well and withing 30-60 seconds of administration.

There have been times when I wished we had IN Fentanyl but unfortunately it isn't an option for some reason.

[akroeze]

Incidently, I remember hearing something about Diaz possibly being safe IN in a new non-alcohol based prep now available? Anyone heard of this?

[Odorono]

Incidently, I remember hearing something about Diaz possibly being safe IN in a new non-alcohol based prep now available? Anyone heard of this?

http://findarticles.com/p/articles/mi_m0EI...25/ai_n27124869

These news releases are all over, but I can't find anything more recent. There was a study done in Iceland 8 years ago which used polyethylene glycol and did show some success in nasal absorption of diazepam.

http://www.pubmedcentral.nih.gov/articlere...i?artid=2014600

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.

Most of our Narcan comes in the 2mg/2mL prefilleds, but one hospital in the area dispenses the 4mg/10mL "family packs," as I like to call them. I'm not sure how much of a problem this will be, since each naris can accommodate up to 2mL of atomized medication, which means you could get up to 1.6 mg into a pt with the more dilute solution. And as firedoc315 pointed out, rapid depression of the plunger is necessary for atomization.

[Odorono]

Going before the regional committee next Thursday with my proposal, among others. Our medical director is on board, so if all else fails I'm pretty confident my service will have IN online soon for at least naloxone.

Question for all those currently using it: were there any initial obstacles from the field medics when it was first implemented? I've heard some rumblings from others that IN is an affront to paramedics' ability to start IVs; just wondering if this is normal and what the responses were. Thanks to all...

[akroeze]

You could say that IO is an affront to medic's ability to start IVs if you want to twist things that way too.

One should never complain about having another option available. Personally I would rather give Midazolam IN to that seizing pt than risk sticking myself with a contaminated needle to get the IV.

Those who don't want to use it won't be forced to.

[FormerEMSLT297]

IS IN that much faster, than IM... thats the route I have always used when we cant get a line..... I know its slower than IV, but it has worked well for me in the past.

Former MAC Certified Medic, now just a trauma junkie

[akroeze]

Even if the onset is identical I would suggest that IN would be preferable due to safety concerns.

Although I don't have the numbers in front of me I would assume (dangerous, I know) that IN would be quicker due to increased vascularity of the area so more surface area for the drug to absorb through.

[firedoc315]

Interestingly in this area, the fire ALS first responders are less likely by far to use IN administration of any medication than the ambulance paramedics by about 7 to 1. They also administer far more IM doses than all ambulance paramedics combined, recently 27 to 4. Wonder what that says about. . .(you know)

[Riblett]

We use the IN route for Versed and Narcan. I have given Narcan by the IN route one time and it did not seem to work very well for me. Also, a lot of it seemed to run out of her nose rather than staying in and working. I may have pushed the plunger too quickly. We finally did get an IV in this patient about 10 minutes after giving 4mg IN (2mg per nostril) and gave 2mg IV Narcan, which seemed to work. Does anyone know what sort of onset we should be expecting? I suppose it may have just been taking a while to work, and when I gave her the IV Narcan it worked right away so we did not see the actual end results. I can see how IN would be a great route on a seizing or psychotic patient, rather than risking an needle stick.

A little aside here, I did shoot Sprite up my co-worker's nose using the atomizer during training just for fun. I thought I was going to have to give her some Versed, cause she freaked, despite the fact it was her idea.