Friday in the ER we had a Pt come in with an alcohol level of 499. He was unconcious and we intubated. Pupils were equal and reactive. The Dr ordered Narcan 0.4 mg IV now. I thought I remember something about not giving Narcan if it is illegal drugs the Pt is on but I cant remember. Help? (The reason he wanted the Narcan was the Pt is a known drug user, crack I think)

Jessica

Depends more on the class of drug and the pt's condition - not necessarily a matter of legal vs. illegal. Especially in the prehospital setting, we tend to reserve Narcan for cases involving opioid (heroin, morphine, etc) overdose with respiratory depression. It can violently precipitate withdrawal in narcotic-addicted pts (or in babies of narcotic-addicted moms), whether the narcotic was legal or not.

Narcan is unlikely to help a patient on crack, but there is a possible benefit if the patient had also taken an opioid. There has been some research into its role in alcohol poisoning and, interestingly, in refractory shock as well.

Here's a link to get you started:

http://eilat.sci.brooklyn.cuny.edu/newnyc/DRUGS/Naloxone.htm

not too long ago a nurse i knew who worked in the va er was presented with a pt everyone who was with him was scraming that he had overdosed [i don't knowwhat is was] anyway she got him converted and he was breathing with a pulse in time for etms to move him to civilian hospital

in an emergency i don't see why a legal drug would be illegal

don't know about its effect with alsohol

In our ER we almost always give narcan to an unconscious person. There is always a chance they OD'd on a legal or illegal opiate, and narcan rarely does any harm and often saves a life.

Actually, narcan is often given if they ARE on illegal drugs, if they are opiates. However, as it reverses the effects of opiates, using it to reverse crack or alcohol would not work.

Many places upon receiving a patient, unconscious from unknown cause, with any possible suspicion of drug abuse, will give narcan. Along with the usual check of blood glucose/D50W injection. Narcan is unlikely to harm (other than killing an addicts "buzz" and sending them into serious withdrawal) and may help. There are few situations where it is not indicated, but the use of illegal drugs generally would not be one of them.

It is also a way to differentiate between a barbiturate OD vs an Opioid OD. Narcan won't reverse a barbiturate OD.

Agree with above posts - presented w/an unconscious patient, blood sugar check and administration of Narcan are the first interventions.

OP, Naxolone (Narcan) is an opioid antagonist, given when possible opioid overdose is suspected. "Overdose" effects of respiratory depression and over-sedation are essentially the same whether caused by street heroin or even properly prescribed analgesics.

Narcan has no bearing on ETOH, crack, or any other non-opiate.

Thanks for all the great responses. So now that I know it is indicated, do you guys usually give a full 2 mg dose?

Jessica

Generally speaking, Narcan works on opioid overdoses.

One should use extreme caution in narcotic-dependent patients as may cause severe withdrawal s/s such as sudden hypertension, tachycardia, cardiac dysrhythmias, and seizure activity.

One may find oneself in a predicament: Treat the respiratory depression and risk tachyarrhythmia or risk respiratory arrest.

Initially, one should administer 1/2 the "normal" Narcan dose; just to adequately improve respiratory status. Goal is not to suddenly precipitate withdrawal s/s. Then, repeat doses of Narcan slowly if necessary.

Another thing to mention is that its not like street drugs come with an ingredient label. Many times our patients take what they think is heroin only to find it laced with fentanyl with deadly results.

Narcan is usually on the protocol for altered level of concsiousness.

Thanks for all the great responses. So now that I know it is indicated, do you guys usually give a full 2 mg dose?

Jessica

I've learned to start small - usually 0.4mg at first. That amount will often be enough to produce some arousal to confirm that you are indeed dealing w/opiate overdose, without producing the fully-awake, pissed-off-that-you-ruined-their high uncontrollable patient. Or wiping out all of the analgesia from an elderly patient w/severe chronic pain who put on one too many Duragesic patches.

Give it slowly and in small doses. I start out at 0.1 mg and repeat in increments of 0.1 mg. - 0.4 mg.

I want to clarify that this is a suspected overdose so my opinion would be different than if someone was post op, etc.

Generally on these boards I find no one more knowledgeable than Siri but wow on this topic I think I disagree with almost everything. I will agree that when giving narcan generally you should avoid giving a sudden and large amount unnecessarily causing frank withdrawal.

Opiate/Opioid withdrawal is not life threatening. It is a case of being subjectively severe and objectively mild as the pt may think they are dying but their clinical sx are rather mild. You really shouldnt have seizures or major arrhythmias although you can see some tachycardia. (There are always exceptions, I think withdrawal in neonates may be associated with seizures and giving narcan to a pregnant addict can cause fetal demise--but I think we are talking a general overdose patient).

As others have posted Narcan is antidotal for opiates/opioid. Also there are reports of it being successful with Clonidine and ace inhibitors. It wont work on Cocaine but will work on other common drugs of abuse such as oxycontin, hydrocodone and heroin.

I also would generally disagree with starting at .1 mg increments with an overdose. I would start at .4 mg if no response then I would go to 2 mg. There really isnt a max dose but if you havent seen a response after 10 mg then you likely wont. Some medications like Propoxyphene will take a large amount of narcan to reverse--generally more than 2 mg.

As others have posted Narcan and dextrose are commonly given to unresponsive patients. You also have to take into consideration the effects of the overdose. Once an opiate has caused hypoxic brain injury then narcan will not be able to reverse that.

Although I do disagree about Narcan causing life threatening withdrawal, I do think you should use caution if they are awake and alert. Don't give it prophylactically, otherwise you will turn an awake or drowsy pt into a combative or sick pt.