Nebulized Naloxone for Acute Opioid Overdose

Paramedics present to an urban emergency department with a middle aged man found unresponsive in a nearby alley The paramedics were unable to obtain IV access due to years of drug abuse and overall poor venous access. Physical Exam General: Middle aged male, unresponsive to painful stimuli Vital signs: P=57/min (sinus bradycardia) RR=5 breaths/min T=97.9 F BP: 165/90 mmHg Pulse Ox=98% on a non re-breather Head: normocephalic, atraumatic ENT: pupils pinpoint, minimally reactive, + gag reflex Lungs: clear to auscultation bilaterally, decreased respiratory rate Cardiac: regular rate and rhythm, no murmur Ext: cool to touch, good pulses, no cyanosis Clinical Course A bedside accu-check of “97” was obtained. There were no obvious signs of trauma. Given the patient’s physical exam findings of pinpoint pupils, depressed respiratory rate, and known history of drug abuse, an opioid toxidrome was recognized and the decision was made to administer naloxone. However, with the patient’s poor venous access, an alternative route of administration was required. Naloxone The growing opioid abuse epidemic has resulted in a skyrocketing number of deaths and ED visits for opioid intoxicated patients. According to the CDC, in 2010 opioid analgesics such as oxycodone, hydrocodone, and methadone, were involved in about 3 of every 4 pharmaceutical overdose deaths (16,651)2. Add in the thousands of heroin overdoses and the need for an effective and rapid reversal agent is clear. Administratio...
Source: EPMonthly.com - Category: Emergency Medicine Authors: Tags: Uncategorized Source Type: news