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EMERGENCY MEDICAL RESPONDERS ANDLAW ENFORCEMENT
Naloxone use
Objectives
In this slide set, you will learn:What naloxone (Narcan) isHow it works when administered to a person
who has overdosed on opioidsHow to recognize the signs of a opioid
overdoseWhen to give naloxone to a person who has
overdosed on opioids
Statistics
Death resulting from heroin overdose has double in the past two years
Death resulting from overdose of prescription pain killers has quadrupled in the past 10 years
Nearly 8,000 people a year die from heroin overdose and 16,000 from overdose of prescription pain killers
Definition
Opioid substances are chemicals that interact with a specific receptor in the brain and cause an expected effect of respiratory depression, sleepiness and small pupils among other things
Examples include heroin, morphine, codeine, dilaudid, oxycodone
Why do people die?1. Too much heroin or other
opioids causes people to become very sleepy.
2. Opioids cause a reduction in breathing rate by acting directly on the brain.
3. This leads to low oxygen levels which causes damage to the heart and brain.
4. Eventually, the heart slows down and stops
Steve’s Law
In 2014, the Minnesota State Legislature passed “Steve’s Law” allowing firefighters and other first responders to administer naloxone to a person who is exhibiting the signs of an opioid overdose.
The bill also allows non-medical, trained lay-persons to administer the medication in the right setting
Authorization
EMR or law enforcement groups who want to provide naloxone will need to get authorization from a licensed physician, physician assistant or advanced practice nurse.
An EMR group must be registered with the state of Minnesota.
Naloxone Naloxone is a
medication available in all hospitals and most ambulances.
It acts in the brain to immediately reverse the effects of the opioid in the person’s system
It last about 45 minutes before it is cleared from the body
Side effects
Naloxone has no side effects and very few people have shown an allergy to the medication
The person could develop vomiting, sweating or shortness of breath once the medication wakes them up These are essentially symptoms of
withdrawal from the opioid and are not unexpected
What does an overdose look like? Signs and symptoms of an opioid
overdoseblue lips and fingernails, a slow pulsevery small pupilsabsent or very slow breathinginability to be woken up.
Act Fast
When you find someone who you think as overdosed, look for the tell tale signs.Are they sleepy and cannot be woken up?Is there breathing very slow or absent?Are their pupils very small?
Treating the patient
Ensure the scene is safe Assess ABCs and treat any immediate
life threats Provide supplemental oxygen as needed If inadequate respiratory effort
open airwayattempt to place an oral airway support the patient’s breathing with
ventilations using a pocket mask or BVM
Administer Naloxone
If the patient has inadequate breathing as well as other signs of opioid overdose, prepare to give Naloxone.The medication can be given intranasally,
intramuscularly or intravenously.Most EMR groups will use the nasal version
while laypersons will likely use the intramuscular version of the medication.
The EVZIO auto-injector of naloxone
Think combination EPI-Pen and AED
Available by prescription
Cost is high, around $500-$700.
The SRHF has received some as a donation
EVZIO - Use The device has
audible instructions that start when the safety cap is removed
Follow the very simple directions
EVZIO
The EVZIO naloxone is no different that other sources.
It is a 0.4mg dose, just like what is given in the typical IM dose.
Use the same injection locations such as thigh or upper arm
The device is ONE-USE ONLY.
Using Naloxone intranasally
Why the nose The nose is a
perfect place to absorb medication
Nasal mucosa gets more blood flow per unit of area than the liver or brain
Many forms of Nalxone
1 mg in 1 ml of fluid 0.4 mg in 1 ml of fluid
Best used for nasal
Best used for intramuscular
Higher concentrated version
Recommendations are to use no more than 0.5 to 1 ml of fluid in a nasal administration since the absorption is worse if more fluid is put into the nose
Nasal Administration
Ensure the persons nose is relatively clear
Attach the medication vial to the syringe Attach the atomizer to the syringe Place the atomizer snuggly against the
nostril opening. Briskly push the medication vial into the
syringe, dispensing ½ of the medication
Nasal Administration
Place the atomizer snuggly against the opening of the other nostril
Briskly push the medication vial into the syringe and dispense the second half of the medication
Continue rescue breaths and recheck the person’s alertness in 2 minutes
Administer a second dose of naloxone if the person is not breathing.
After care
Prepare patient for transport The patient should be transported to an
Emergency Department due the relative short-term effects of Naloxone.
Save a life
You can not harm someone by giving them naloxone
In many cases, you will safe a life.
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