narcan question

NYCRN16 · Jul 24, 2006

I know you can definitly give it through an ET tube, and I believe you can also give it SQ but I dont know why anyone would do that unless there was truly no other way.

troutfishinEMT · Jul 24, 2006

Hate to say this, but, um, if you gave a pt ANYTHING through an ET tube, it would end up... in their lungs, right?

And narcan is inactivated if given orally - so to answer the ops original question - it can be given sq, iv, as well as im, although for obvious reasons, I've never seen it given any other way than IV.

Editorial Team / Admin · Jul 24, 2006

Yes, Narcan may be given IV, SubQ, IM and via ET.

http://www.biotel.ws/protocolsHTML/Protocols2004/Pharmacology/NaloxoneHCL.asp

skipaway · Jul 24, 2006

Hate to say this, but, um, if you gave a pt ANYTHING through an ET tube, it would end up... in their lungs, right?

The lungs have a great vascular supply and therefore drugs can be given down an ETT in an emergency situation. Those drugs are:

Epinephrine

Atropine

Lidocaine

Narcan

and one that's not given as much

Valium

All need to be diluted with NS and also "chased" by 10cc NS after giving the drug.

ACLS teaches this method if IV access is not obtainable.

skipaway, crna

troutfishinEMT · Jul 24, 2006

Well I'll be - never seen that or heard of it. Of course, that is one of the things I love about EMS/ED - see and learn new stuff every day.

Thanks for the info!

Gompers, BSN, RN · Jul 24, 2006

Yep, we give Narcan down the ETT in the delivery room if a baby has respiratory depression from narcotics the mom got in labor. We also give epinepherine that way if the baby is in arrest. Both these types of babies need to be intubated for ventilation anyways, and giving the meds down the tube is a lot more convenient than having to start an IV on a two minute old baby.

I didn't know you could give Valium down the tube, though! The closest I've come to that is to give Versed intranasally for emergency sedation.

EricJRN, MSN, RN · Jul 24, 2006

There's also the intranasal route, but it's slow, equal to or slightly slower than IM.

RunnerRN, BSN, RN · Jul 24, 2006

Aren't ACLS guidelines changing though? My understanding is that they will no longer have ET meds in the guidelines - since you have to double or triple the dose, and still sometimes aren't effective - and are going to IOs being used more frequently. How scary is that? I forsee a lot of unnecessary IOs being placed in the field "just because we can" and "just because we have the EZ-IO". Not that IO access isn't a good thing - if I am coding, feel free to EZ-IO me all day long. BUT I think when ACLS says something is okay, or more acceptable (for a lot of ppl, both pre-hospital and in the ER/units/etc), it comes into more common use.

Altra, BSN, RN · Jul 24, 2006

I think of Narcan as a RIGHT NOW med ... IV or down the ETT. Can someone who has experience giving it IM or SQ (delayed onset) explain why this would be done?

EricJRN, MSN, RN · Jul 24, 2006

In some jurisdictions, certain providers are trained to administer IM injections but cannot give IV meds.

I'm also thinking of an EMS call I ran a while back. CPR in progress at a residence. The patient had a very anterior trachea and was impossible to tube. The veins were also very problematic and no IV could be started. We went for a sternal IO. You know that tiny percentage (I think 1-2%) of failures they tell you about with that device? Yep - that was me. The entire device lodged in the pt's sternum and wouldn't release, but we finally dislodged the device so that we could continue CPR. Bad day, very bad day.

Now on that call, there were no indications for Narcan, but if there had been, it would have been nice to have some other options (even if not ideal) besides IV/ET.

Larry77, RN · Jul 24, 2006

If we have an unresponsive OD patient we often give a dose of Narcan IM while we are trying to optain IV access and then usually give another dose IV.