Nebulized narcan?

[ambodriver]

I've seen nebulized narcan for the person wheezing after taking heroin. The pt. was also lethargic but alert enough to fight off an IV attempt.

"I just want my albuteroll bitch!"

It worked, albeit slowly. By the time the ambulance got to the ER there was one pissed off druggie.

http://www.jem-journal.com/article/S0736-4679%2802%2900723-0/abstract

[speedygodzilla]

I've seen nebulized narcan for the person wheezing after taking heroin. The pt. was also lethargic but alert enough to fight off an IV attempt.

"I just want my albuteroll bitch!"

It worked, albeit slowly. By the time the ambulance got to the ER there was one pissed off druggie.

http://www.jem-journal.com/article/S0736-4679%2802%2900723-0/abstract

Interesting little case study. That was my initial thought on it. Giving narcan nebulize would allow a slower and more gradually onset thus preventing the all the sudden effects and the fighting patient.

I have no desire to give patients narcan any route who are still maintaining airway and breathing adequately. That being said I don't see too many opportunities to give narcan nebulized but that case study in the above links brings up a good point. Nebulize should allow a more gradually onset thus preventing the sudden fighting patient. Still have to say IV would be my preferred route. But I am wondering if nebulize would be more effective than IM. And at least with nebulized you could stop administration when desired effects are reached.

[kohlerrf]

In the situation where I would think of narcan the pt generally would not be able to self administrate it by holding onto a nebulizer. While i have done RSI and intubated say a bad asthmatic and nebulized medication into the ET tube, considering the time it would take to set up and the onset of nebulized narcan ist use may cross over into neglagence. we currently have at our disposal IV,IO,IN and ET all of which would have a faster onset of therapudic effect. While it is interesting that narcan can be neutralized I dont see its practicality.

[Riblett]

I have given intranasal Narcan several times with good effect, which beats the hell out of trying to get a vein on a junkie. And while I have my reservations about endotracheal administration of any drug, it would seem that since Narcan can be given ET and IN, it can be given as a neb. HOWEVER, why would you want to give nebulized Narcan? The purpose of Narcan is to reverse respiratory depression or apnea resulting from narcotic overdose. Unless the person's breathing is depressed or apneic, Narcan isn't indicated. And patients who fall into that category wouldn't be appropriate or effective to administer any drug via neb anyway.

Unless you just want to get the crap beaten out of you don't go giving Narcan to someone just to wake them up. It's not candy and it's not a benign drug contrary to widespread belief; it can cause withdrawal seizures and delirium for chronic addicts. And even those 80 year-old grannies can swing a cane pretty hard when the come to, especially if they have been on pain meds for a couple decades. With the ability to give IM, IN, and IV, I don't really see any clinical indication for nebulized Narcan.

Edited October 13, 2010 by Riblett