Benzo Overdose

[chbare]

I'm still not convinced. Bagging a patient can be difficult without adding in the time and logistics of bagging naloxone in a patient with an already compromised airway. Is there a good base of evidence to support this? This has been discussed here before and I'm still not won over by the evidence that I've seen.

This may be a more effective and safer way to do things; however, I have not seen anything to convince me it's safer or better than current methods.

[zmedic]

I'm still not convinced. Bagging a patient can be difficult without adding in the time and logistics of bagging naloxone in a patient with an already compromised airway. Is there a good base of evidence to support this? This has been discussed here before and I'm still not won over by the evidence that I've seen.

http://www.emtcity.c...bulized-narcan/

This may be a more effective and safer way to do things; however, I have not seen anything to convince me it's safer or better than current methods.

The benefit is that nebulized (or more commonly intra nasal spray with an atomizer) gives you the ability to have people like EMTs or bystanders who don't have the ability to give IM/IV drugs to give Narcan. There are a lot of rural places that don't have medics and have a big problem with opiods. Narcan is a pretty safe med and narcan up the nose sure beats bagging the patient for an hour.

[chbare]

I am on board with the intranasal spray; however, the conversation is not about IN delivery. In fact, the person does not have IN capabilities and is looking at literally adding it to a small volume nebuliser and administering it by mask or by bagging the nebulised medication into the patient.

I am not convinced that this is a superior method at this point in time. Again, I agree with you on the IN delivery. My state has guidelines that specifically allow this via the MAD device.

[tcripp]

I am not convinced that this is a superior method at this point in time. Again, I agree with you on the IN delivery. My state has guidelines that specifically allow this via the MAD device.

Not suggesting that a Narcan neb is superior...just an alternative to help minimize the amount delivered to ensure "titrate" has been met.

[chbare]

I would call it a "potential" alternative because I am not appreciating loads of evidence other than a few case studies regarding it's efficacy. If you are really wanting to implement modalities other than parenteral, your best bet is to push for IN administration. You can find a fair amount of evidence regarding it's use and several states not to mention numerous services are using this modality effectively.

EDIT: "find"

Edited November 27, 2011 by chbare

[croaker260]

. Narcan is a pretty safe med and narcan up the nose sure beats bagging the patient for an hour.

1- I am a big fan of the IN route... but only as an option when traditional IV access is not practical.

2- Frequently 5-10 minutes of good proper BVM oxygenation AND ventilation will restore some respiratory function in the recreational OD. If this tactic works, then bagging them is not an issue, and neither is Narcan.

2- If aspiration has already occured, you are better off bagging or placing the advanced airway de-jour than giving narcan... Respiratory failure is likely and giving Narcan will only complicate management.

3- Without getting too sideways on Narcan, narcan in a clinical vacuum is a safe drug, narcan used on the street with all the clinical variables we find in real patients can be a time bomb if you dont understand the "why's" and "whats" going on behind the scenes, especially with poly-pharm and hypoxic/acidotic patients.

4- I see your point of rural BLS services and bagging for an hour, but I am a huge fan of alternative airways for BLS services, and there are BLS devices such as the NuMask (www.numask.com and no I am not a sales rep ) that are viable options as well. I bring this up because Narcan is one of those drugs you can cause more problems than you solve....especially if you dont have all the options for airway management (i.e. RSI/MAI and sedation) when things go sideways. If you can managem the patient with oxygenation and ventilation...often you are better off doing that.

For a better explanation of my views on Narcan... look here:

http://www.emtcity.c...-ems-providers/

Why not do an inline neb while you are bagging?

See my comments above about bagging, oxygenation, and ventilation.

I think we can all agree its a possible tool in the tool box, but I agree its bioavailability is not well understood or researched. And since ETT administration of any drug, narcan included, is regarded as unpredictable in its absorption... the (relatively) well researched 80% bioavailability of IN narcan when compared to IV narcan is predictable and acceptable.

Why is this important? Because with Narcan...LESS is MORE (even more so than other drugs) . And the ability to give predictable small amounts is crucial to avoiding complications, especially in poly pharm OD's.

So yes, its an interesting option in the back of your head.I agree. But I agree also with chbare that there are a lot better options usually available, including not giving it at all.

Respectfully submitted:

Croaker

Edited November 28, 2011 by croaker260