Does IM Narcan have any benefit in a cardiac arrest patient?

I've never heard of IM Narcan? It would take so long to be absorbed as to be useless. However, IV Narcan is utilized in some arrest situations where the exact cause of the arrest is unknown. We used it frequently in the ER with the "man found down" scenarios.

I'm surprised...I just looked up narcan, and indeed it can be given IM; longer acting, apparently

too long of an onset for codes though, it would seem more efficient to just get a vein

or you can give narcan via ETT as well

Not exactly cardiac arrest situations, but I worked in a freestanding (non hospital) detox where we routinely gave IM Narcan 1mg Q5min up to 10 doses with patients who had OD'd ... obviously while EMS was on the way and O2 and Defibrillator on hand. Worked pretty well to wake em up, unless there were benzos on board too.

IV narcan is much safer and faster and much more predictable onset of action.

I never heard of IV Narcan given for anything other than opioid OD. Seen it used when a respiratory arrest caused by opioids is suspected. Ever seen the movie Trainspotting? Classic example of Narcan administration in that!

I am currently on assignment near the Heroin capital of the US (Wierdly a small place called Chimayo NM) The cops carry Narcan here and can administer it IM, as they usually arrive first on the scene, in cases where IV access is difficult, it, along with supporting respiratory function works very very well.

IV access is of course more appropriate, but IM narcan can and does work. In fact they are now making Drug rescue kits for addicts that includes some sort of inhaled Narcan.

The only benefit of IM narcan I could see in a Cardiac Arrest patient would be if the arrest were due to OD, and there was no way to gain venous access.

We always prefer to give it IV, but there are some cases where the addict has no veins, and has been injecting themselves actually in the neck so even the neck is all messed up.

I've only usually given it IM once, immediately and then started the IV. It may seem like a lot, but lately the standard narcan dose has not been reversing our patients, they are requiring somewhat more.

And yes,I am looking forward to my next assignment, somewhere else.

I've given narcan IM only when IV access was UTO or delayed. In the case of cardiac arrest, it would seem more appropriate to just administer it via ET rather than giving narcan IM to a hypoperfused patient.

I've given narcan IM only when IV access was UTO or delayed. In the case of cardiac arrest, it would seem more appropriate to just administer it via ET rather than giving narcan IM to a hypoperfused patient.

Exactly. IM Narcan on an unconscious patient who's hemodynamically stable is fine - perfusion will help the med be effective. However, the use of Narcan on a patient who's coding isn't going to do any good, even with good compressions. On the other hand,when nebulized thru the ET tube, Narcan is much faster and more effective.

iv narcan is much safer and faster and much more predictable onset of action.

actually it depends on your goal.....

in europe, it's common practice to treat an acute overdose on the scene with enough narcan to bring them back to "planet earth," then administer 2mg im and leave the patient where you found them, only alert, oriented, and breathing!!!! and having taken care of more than my share of od patients, i think it sounds like a great idea, yet it will never catch on here in america (too many lawyers!!!!)!!!!

SeoBow, thats pretty much what we are doing in New Mexico. The only thing is that we observe them for a while because sometimes the narcan wears off before all the drugs do and they need repeat doses. After a certain numberof hours, we send them home. Only to see them again next week.

In the last 13 weeks, I've seen enough OD's and shooter's abcesses to last me a lifetime...

SeoBow, thats pretty much what we are doing in New Mexico.

Is that going on in the prehospital setting? My immediate reaction was to agree with SEO that it was a bit too radical for the US.

As I explained in my other post, in our area of NM, some police officers carry narcan and give it. but the patient is always transported to the hospital. Our issue is that occasionally it takes more than one dose of 2 mg of Narcan, the narcan wears off and the heroin is still working and the pt gets Respiratory compromise again. this is the concern here, and I have defintiely seen it occur. The Heroin OD is seen here at least once a day if not more often, more common than any of the other hosptials I've been at. It's an on going cycle here I've actually treated a patient their mother and their grandpa for Heroin OD all in the same week.

In the US they are also giving Heroin users "rescue kits" now with some form of narcan )Inhaled or injected I dont know). I heard it on NPR, then had it confirmed by a lady who does needle exchange out here.