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Discussion

Administering Narcan: Fast or Slow?

I'm new to the ER and had to give my first dose of Narcan last night. The nurse that was orienting me told me to push it very slowly to keep the pt from vomiting, so I pushed 1mL over about 3 minutes. As I was almost done, another nurse came into the room and asked me what I was doing. I explained that I was pushing the Narcan slow like I was told to, but she said it wasn't necessary and that they usually just push it as fast as a flush would be pushed. I checked my Davis' Drug Guide online and it said nothing about administering it slowly, but I Googled it and found an even mix. Some even say administering it quickly can be dangerous because it puts them into sudden withdrawal and increases the risk of pulmonary edema.

So I respectfully ask the experienced ER nurses, how do YOU administer Narcan?

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    Generally, I give naloxone over 1 to 2 minutes. Rapid administration can cause vomiting, as your preceptor mentioned. Why risk them vomiting and aspirating?

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    Push it slow. General rule of thumb is only push fast if they're dead (major exception being adenosine).

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    Fast, at my hospital we give it only when they are close to being bagged, and only enough to get them breathing.

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    I've seen the flash pulmonary edema firsthand with just 0.4mg pushed quickly. Even in cases of OD, I'm more inclined to push slowly or at least dilute it in 10cc NSS. Even though the opiate can be reversed, you're going to be dealing with a way worse airway issue if the pt has frothy sputum spewing out of their mouth and nose!

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