Opioid Toxicity Medical Directive

Question 1

What are the indications?

Answer 1

• Altered LOC AND
• Respiratory depression AND
• Inability to adequately ventilate, OR persistent need to assist ventilations; AND
• Suspected opioid overdose

Question 2

What are the conditions for naloxone?

Answer 2

• Age= >24 hrs
• LOA= altered
• RR= <10 breaths/ min

Question 3

What are the contraindications for naloxone?

Answer 3

• Allergy or sensitivity to naloxone

Question 4

What is the treatment for naloxone? (Route IV)

Answer 4

• Dose= up to 0.4mg
• Max. single dose= 0.4mg
• Dosing interval= 5 min
• Max. # of doses= 3
• For the IV route, titrate naloxone only to restore the pt’s resp status

Question 5

What is the treatment for naloxone? (Route IM)

Answer 5

• Dose= up to 0.4mg
• Max. single dose= 0.4mg
• Dosing interval= 5 min
• Max. # of doses= 3

Question 6

What is the treatment for naloxone? (Route IN)

Answer 6

• Dose= 2-4mg
• Max. single dose= 2-4mg
• Dosing interval= 5 min
• Max. # of doses= 3

Question 7

What is the treatment for naloxone? (Route SC)

Answer 7

• Dose= 0.8mg
• Max. single dose= 0.8mg
• Dosing interval= 5 min
• Max. # of doses= 3

Question 8

What are the clinical considerations?

Answer 8

• IV administration of naloxone applies only to PCPs authorized for PCP Autonomous IV
• Upfront aggressive management of the airway is paramount and the initial priority
• If no response to initial tx; consider patching for further doses
• If the pt does not respond to airway management and the administration of naloxone, glucometry should be considered
• 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; respiratory rate >10, adequate airway and ventilation, not full alertness