Indications: Should a patient have an altered LOA and respiratory depression and suspected overdose.
Nalaxone: If the patient is ≥ 18 years of age with an altered LOA with a respiratory rate less than 10 breaths per minute and does not have an allergy or sensitivity to naloxone and is not hypoglycemic administer naloxone 0.8mg via SC or IM or IN to a maximum single dose of 0.8mg. Repeat doses may be administered at 10 minute intervals to a maximum of 3 doses in total
If administering naloxone via IV titrate only to restore the patient’s respiratory status up to a maximum dose of 0.4mg.
- Administer 100% oxygen and apply cardiac monitor. Manage airway and assist ventilations as required. Ventilatory management is of primary importance.
- Consider initiating IV access. IV access may be difficult and should be limited to 2 attempts or 3 minutes on scene.
- Perform blood glucometry. If < 4 mmol/L then consult the Altered LOC – Suspected Hypoglycemia Protocol.
- If blood sugar is ≥ 4 mmol/l the paramedic may contact the BHP for orders to administer naloxone (Narcan). Naloxone may be administered (by BHP order) in an adult at a starting does of 0.4mg IV. If IV access is unavailable, naloxone 0.8 mg may be administered (by BHP order) subcutaneous (SC), intramuscular (IM), or intranasal (IN). This may be repeated every 5 minutes to a maximum dose of 2 mg.
- Monitor respiratory status and initiate transport.
- If no improvement, consider intubation if not already done.