Narcan Flashcards
Route for naloxone
IN or IM
inclusions for naloxone
-Pt. is 4 yo or more.
-suspicion overdose ou mauvais dosage de narcotique
-AVPU: P-U
-badypné
12ans et plus: FR≤10
4-11 and: FR≤16
exclusions for naloxone
-AUCUN POUR LA 1E DOSE….
2e dose:
- allergie au narcan
- convulsion
dosage of naloxone
IN: 0.4mg (MAX 3X) then 2,0 mg *alterner narines (1mg in each narine for final dose)
IM: 0,4mg (MAX3X) then 2,0 mg
repetition rate of naloxone
IN: q.3 mins
IM: q.5 mins
therapeutic effects of naloxone
will temporarily inhibit the effects of the opioids on the body
side effects of naloxone
Tachycardie, Hypertension, irritability, dizziness, weakness, agitation, Nausée, Vomissement, Trembling, Diaphorèse, Sevrage (de l’opioide) et OAP.
what do you verify to know if the pt. took opioids (TOXIDROME)?
- Hx de consommation?
- AVPU: PU
- hypoventilation
- myosis (pupilles super petites)
- EXPOSE: tract marks, fentanyl patches
if a PR or any témoin gaved narcan before you arrive, what do you do?
give YOUR OWN according to MED12.
what do you want to verify on this type of call?
- Trauma due to conso. (eg: Fall)
- CBGM to exclude MED16 before 1st dose or after 2nd if no amélioration with narcan as pt. could be unconscious bcs of hypoglycemia (even if took drugs!) (Source:QR2018)
- GI symptoms
- LOC
- HX
- Pupilles
- Expose body
after all narcan is given but pt. doesnt react to it (breathing or état de consience)…. what do you do?
help pt. breath for 3 more mins then INTUBATE him (REA7)
how long does narcan works for (Durée d’action)?
30-60 mins (more 30 tho!)
what could happen if narcan wears out? why? what TAP can do?
pt. goes back to P-U state and hypoventilation as the opioid is still in his system although narcan wore off… TAP can restart MED12 narcan administration from the 1st dose. But, generally one dose will be enough to bring him back.
do you give O2 with narcan?
depends on SPO2 but could help A LOT!
si le pt. est en ACR, comment donner Narcan (dosage, repetition)
2mg (IN or IM) before the 2nd analyse and another 2mg (IN or IM) before the 3rd analyse…
**NEVER INTERRUPT CPR!!*
**always give 1mg in each nostril when giving 2mg
if there is liquid of powder what should you do to protect yourself from the effects of the drugs?
put a surgical MASK on
do you keep the patches and drugs found?
yep! bring them to the CH and watch out not to touch the patches with your skin directly (GLOVES!)
what information can you get from bystanders that is SUPER important in an opioid overdose case?
try to get what they took, when (exact time), how much, how they took it (route) and if they vomited.
wich route is prefered for narcan?
IN (less invasive)… now with covid IM is better as there is less aerosoles.
when do you start evacuation of the pt. when giving naloxone?
after 1st dose
source:(Q&A 2018)
in between 2 doses of narcan (IN), what do you do with the inhaler (white thing)?
keep it in the plastic bag it came in!
is GHB a drug you can give narcan for?
no
source: (Q&A 2018)
How long does Narcan takes to work on the body?
3-5 mins (IM), 1-2 min (IN)… this is also why IN is the best route!!
name some opioids
codeine, fentanyl, methadone, morphine, oxycodone,dilaudid, etc.
what is the number one priority with a hypoventilating pt in MED12?
1 = Support ventilatoire (OXY) 2= Nalox 3= Combitube
Quelle classification est le Nalox?
Antagoniste de Narcotiques
How does Narcan works (Mécanisme d’action)?
Il va s’attacher sur les même récepteurs que les opioïdes et remplacer ceux-ci mais ne créera PAS d’effet (comme une clée dans une mauvaise serrure). L’opioïde sera alors détaché et remplacé. Il flottera donc librement dans le système jusqu’à ce qu’il soit éliminé par le corps (PLUS LONG QUE NARCAN).
Narcan est donc l’antidote puisqu’il prévient une molécule d’opioïde de s’attacher sur le récepteur et ainsi en prévient également son effet.
Les opioides proviennent de ou?
- Naturel: Plante de opium (Pavot)
- Synthétique (en labo)
À quoi sert les opioïdes normalement?
À inhiber la perception de la douleur
Some effects opioids have on people?
- constipation
- hypoventilation
- apnea
- release histamine…. so vasodilatation…. so OAP
- collapsus vasculaire (TRES RARE) - BP sous 80
- Last one can lead to choc!
- ACR (due to respiratory depression)
Opioids work on the parasympathetic or sympathetic system?
sympathetic
**henses the myosis as this system is fully stopped (only the parasympathetic works!!)
Naloxone Vs Narcan……
Which one is the generic and commercial name?
Naloxone: Generic
Narcan:Commercial
comment Narcan peut mener à un OAP?
Narcan engage un retour SOUDAIN de système sympathique. Créant ainsi un relâchement de catécholamine (adrénaline et noradrenaline). Ceci peut donc causer une augmentation de la pression intrapulmonaire et augmenter la perméabilité des capillaire. Ceci créera alors un OAP si le patient est hypoxique ou mal ventilé.
est-ce que le Narcan est bien absorbé lors de l’ACR?
no as there’s not as much blood circulation.
do you keep giving narcan once intubated on a code?
HELL NO!! You first give narcan to prevent intubating during a cardiac arrest… Goal is to give a quickstart to the sympathetic system (to stop the adrenergic blockage)…. This way it could potentially bring back a pulse and BP if it is a PEA type of arrest.
But, NO MORE narcan as he could choke on the tube and you’ll need to extubate.
Source: QR2018
What could cause you to stop giving Narcan?
- get additional info that the pt. had a mixed consommation that includes adrenergic stimulants (eg: epinephrine, dopamine, etc.)
- MAJOR increase of BP and pulse (still can intubate if inclusions are there!).
Source: QR2018
