ALS PCS: Opioid Toxicity Medical Directive

Question 1

Indications

Answer 1

Altered LOC
AND
Respiratory Depression
AND
Inability to Adequately Ventilate
AND
Suspected Opioid Overdose

Question 2

Naloxone Conditions

Answer 2

≥ 12
Altered
RR < 10brpm

Question 3

Naloxone Contraindications

Answer 3

Allergy or sensitivity to Naloxone;

Uncorrected hypoglycemia

Question 4

Treatment

Sub-Q

Answer 4

Dose: 0.8mg
Max single dose: 0.8mg
Q10 x 3

Question 5

Treatment

IM

Answer 5

Dose: 0.8mg
Max single dose: 0.8mg
Q10 x 3

Question 6

Treatment

IN

Answer 6

Dose: 0.8mg
Max single dose: 0.8mg
Q10 x 3

Question 7

Treatment

IV

Answer 7

Dose: Up to 0.4mg
Max single dose: 0.4mg
Q0 x 3

Question 8

Clinical Considerations

Answer 8

IV admin applies only to PCPs authorized for PCP Autonomous IV.

Naloxone may unmask alternative toxidromes in mixed OD situations leading to possible seizures, hypertensive crisis, etc.

Naloxone is shorter acting than most narcotics and these pts are at high risk of having a recurrence of their narcotic effect. Every effort should be made to transport pt to closest appropriate receiving facility for ongoing monitoring.

Combative behaviour should be anticipated following Naloxone administration and paramedics should protect themselves accordingly, thus the importance of gradual titrating (if given IV) to desired clinical effect: RR ≥ 10brpm, adequate airway and ventilation, not full alertness. If adequate ventilation and oxygenation can be accomplished with BVM and basic airway management, this is preferred over Naloxone administration.