2. Naloxone use

3. Objectives  In this slide set, you will learn: What naloxone (Narcan) is How it works when administered to a person who has overdosed on opioids How to recognize the signs of a opioid overdose When to give naloxone to a person who has overdosed on opioids

4. Statistics  Death resulting from heroin overdose has doubled in the past two years  Death resulting from overdose of prescription pain killers has quadrupled in the past 10 years  Nearly 8,000 people a year die from heroin overdose and 16,000 from overdose of prescription pain killers

5. Definition  Opioid substances are chemicals that interact with a specific receptor in the brain and cause an expected effect of respiratory depression, sleepiness and small pupils among other things  Examples include heroin, morphine, codeine, dilaudid, oxycodone

6. Why do people die? 1. Too much heroin or other opioids causes people to become very sleepy. 2. Opioids cause a reduction in breathing rate by acting directly on the brain. 3. This leads to low oxygen levels which causes damage to the heart and brain. 4. Eventually, the heart slows down and stops

7. Steve’s Law  In 2014, the Minnesota State Legislature passed “Steve’s Law” allowing firefighters and other first responders to administer naloxone to a person who is exhibiting the signs of an opioid overdose.  The bill also allows non-medical, trained lay-persons to administer the medication in the right setting

8. Authorization  EMR or law enforcement groups who want to provide naloxone will need to get authorization from a licensed physician, physician assistant or advanced practice nurse.

9. Naloxone  Naloxone is a medication available in all hospitals and most ambulances.  It acts in the brain to immediately reverse the effects of the opioid in the person’s system  It last about 45 minutes before it is cleared from the body

10. Side effects  Naloxone has no side effects and very few people have shown an allergy to the medication  The person could develop vomiting, sweating or shortness of breath once the medication wakes them up These are essentially symptoms of withdrawal from the opioid and are not unexpected

11. What does an overdose look like?  Signs and symptoms of an opioid overdose blue lips and fingernails, a slow pulse very small pupils absent or very slow breathing inability to be woken up.

12. Act Fast  When you find someone who you think as overdosed, look for the tell tale signs. Are they sleepy and cannot be woken up? Is their breathing very slow or absent? Are their pupils very small?

13. Treating the patient  Ensure the scene is safe  Assess ABCs and treat any immediate life threats  If inadequate respiratory effort open airway attempt to place an oral airway support the patient’s breathing with ventilations using a pocket mask or BVM  Provide supplemental oxygen as needed

14. Rescue Breaths  Use Pocket Mask or BVM  1 breath every 5 seconds  Chest should rise, not stomach

15. Administer Naloxone  If the patient has inadequate breathing as well as other signs of opioid overdose, prepare to give Naloxone. The medication can be given intranasally, intramuscularly or intravenously. Most EMR groups will use the nasal version while laypersons will likely use the intramuscular version of the medication.

16. The EVZIO auto-injector of naloxone  Think combination EPI-Pen and AED  Available by prescription  Cost is high, around $500-$700.  The SRHF has received some as a donation

17. EVZIO - Use  The device has audible instructions that start when the safety cap is removed  Follow the very simple directions

18. EVZIO  The EVZIO naloxone is no different that other sources.  It is a 0.4mg dose, just like what is given in the typical IM dose.  Use the same injection locations such as thigh or upper arm  The device is ONE-USE ONLY.

19. Using Naloxone intranasally

20. Why the nose  The nose is a perfect place to absorb medication  Nasal mucosa gets more blood flow per unit of area than the liver or brain

21. Many forms of Nalxone 1 mg in 1 ml of fluid0.4 mg in 1 ml of fluid  Best used for nasal  Best used for intramuscular

22. Higher concentrated version  Recommendations are to use no more than 0.5 to 1 ml of fluid in a nasal administration since the absorption is worse if more fluid is put into the nose

23. Nasal Administration  Ensure the persons nose is relatively clear  Attach the medication vial to the syringe  Attach the atomizer to the syringe  Place the atomizer snuggly against the nostril opening.  Briskly push the medication vial into the syringe, dispensing ½ of the medication

24. Nasal Administration  Place the atomizer snuggly against the opening of the other nostril  Briskly push the medication vial into the syringe and dispense the second half of the medication  Continue rescue breaths and recheck the person’s alertness in 2 minutes  Administer a second dose of naloxone if the person is not breathing.

25. Use in Children  Naloxone is safe for use in children  It is commonly used in the neonatal intensive care unit on very young children  For the purposes of EMR and layperson life saving interventions, the dose is the same as adult.

26. After care  Prepare patient for transport  The patient should be transported to an Emergency Department due the relative short-term effects of Naloxone.  Consider using a legal hold to facilitate this as needed.

27. Narcan Storage  How should I store Narcan Nasal Spray?  Store Narcan Nasal Spray at room temperature between 59°F to 77°F (15°C to 25°C).  Narcan Nasal Spray may be stored for short periods between 39°F to 104°F (4°C to 40°C).  Do not freeze the nasal spray.  Keep the nasal spray in its box until ready to use.  Protect from light.  Replace the nasal spray before the expiration date on the box.  Keep all medicines out of the reach of children and pets.

28. Save a life  You can not harm someone by giving them naloxone  In many cases, you will save a life.

29. Narcan Use Reporting tool: www.sc-ems.org Enter Username and PW from Narcan Card

30. Narcan Use Reporting tool: Click on Narcan vial at top of page

31. Narcan Use Reporting tool: Enter information requested and Submit

32. FOR MORE INFORMATION VISIT OUR WEBSITE AT WWW.SteveRummlerHopeFoundation.org EMAIL US AT Hope@SteveRummlerHopeFoundation.org Find us on Facebook or Twitter @SRHopeF FOR MORE INFORMATION VISIT OUR WEBSITE AT WWW.SteveRummlerHopeFoundation.org EMAIL US AT Hope@SteveRummlerHopeFoundation.org Find us on Facebook or Twitter @SRHopeF