narcan question

heartICU · Jul 25, 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?

I have given it IV and then also given in IM (in the same patient)...the IM dose is to help prevent renarcosis when the IV is coming off its peak.

Larry77, RN · Jul 25, 2006

I have given it IV and then also given in IM (in the same patient)...the IM dose is to help prevent renarcosis when the IV is coming off its peak.

Yes, or if the Pt is an IV drug user (in our area is usually the case), it takes awhile to find a descent vein so the IM dose starts working even before we get the IV dose in.

nuangel1, BSN, RN · Jul 25, 2006

once i have given it im .pt was unrsponsive and renal pt no iv access till cl placed.

gonzo1, ASN, RN · Jul 25, 2006

Thanks for all the input. I placed the question because we had a pt come in complaining of pain and gave IM dilauded 1mg, wanted to keep things simple. A few minutes later wife comes screaming out saying something wasn't right with him. We all ran in and he was barely breathing. Doc says to give narcan and even our experienced er rn's freaked out because there was no IV site. Even the doctor didn't know what to do. I was sure I had read it could be given multiple ways, but no one seemed to know so we bagged the guy till IV was put in. I decided that would never happen again and came home and researched the heck out of this. Next time something like this happens I can really shine with all my new found knowledge. Thanks for the education. I do find it really amusing that the er doc didn't know how it could be given.

vamedic4, EMT-P · Jul 25, 2006

We've given narcan sub q...slower absorption, longer duration of action, for pt. given 10x the dose of morphine ( RN had orders for .3 mg, gave 3.0 mg). That was given in addition to the IV narcan.

vamedic4, EMT-P · Jul 25, 2006

Skipaway is correct....remember NAVEL...meds that can be given down the tube....

Narcan

Atropine

Valium

Epi

Lidocaine

chase it w/ NS and nebulize by bagging.

vamedic4;)

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

vamedic4, EMT-P · Jul 25, 2006

Sadly, NurseErica, you may be correct about the ET route of administration. Seems the perception of prehospital intubation has come under fire lately, with "experts" doing studies about the effectiveness of field intubation. Hence the drive "away" from this procedure in an effort to reduce mistakes commonly associated with it. And that takes away an important route of administration for meds...ET.

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 26, 2006

We've given narcan sub q...slower absorption, longer duration of action, for pt. given 10x the dose of morphine ( RN had orders for .3 mg, gave 3.0 mg). That was given in addition to the IV narcan.

Not to hijack the thread ... but this was a pedi pt., right?

vamedic4, EMT-P · Jul 26, 2006

Not to hijack the thread ... but this was a pedi pt., right?

Oh, yes. And I bagged her until shift change. She came out and did just fine.

gonzo1, ASN, RN · Jul 26, 2006

pt was an older gentleman.