1. Naloxone formulation update
October 2014

2. 3) If no change after 3 – 5 min repeat naloxone
Overdose Suspected
No Pulse
Check Pulse
1) Administer Naloxone
2) Rescue breathing
3) If no change after 3 – 5 min repeat naloxone
4) Rescue breathing until help arrives
1) 2 min of CPR, 5 Cycles
2) Administer Naloxone
3) Apply Defibrillator
4) Follow Defib. prompts
5) Continue CPR
Pulse
If you suspect an overdose (not breathing or slow breathing, blue lips or finger tips ect.), check the pulse
If no pulse and with 2 or more responders, administer naloxone during first 5 cycles of CPR
Also, if you have another person with you, one person can be putting together the narcan and/or doing crowd control and keeping area safe, while another is doing the rescue breathing

3. Remember “Four Rights” for medication administration
Massachusetts Office of Emergency Medical Services Minimum Standards for First Responder Training in First Aid, Epinephrine Auto-Injector and Naloxone Use AR-2-100
Right Patient (opioid overdose)
Right Medication (Naloxone-check for clarity)
Right Date (check expiration)
Right Dose (spray half (1ml) in each nostril)

4. Naloxone formulations
Intranasal
Auto-injector

5. Intranasal Naloxone
Intranasal naloxone needs to be dispensed with the mucosal atomization device
If there is nasal trauma or bleeding, do not administer naloxone
Benefits of Intranasal Naloxone
Nose is an easy access point
Painless
Eliminates risk of contaminated needle sticks and needle dispensing
Key Point: Benefits of intranasal naloxone

6. Give Naloxone: Intranasal
Remove both yellow caps from the ends of the syringe
Twist the nasal atomizer onto the tip of the syringe
Remove the purple cap from the naloxone
Twist the naloxone on the other side of the syringe
Review how to put together naloxone kit.
Interactive: have participants put together demo naloxone kits

7. Give Naloxone: Intranasal
Push 1ml (1mg) of naloxone into each nostril
Administer the entire contents of the 2ml syringe with approximately one half (1ml) administered in each nostril
Administering one half in each nostril maximizes absorption

8. Auto-injector Naloxone
Each auto-injector contains only 1 dose
Inject into muscle or skin of the outer thigh
Can be injected through clothing if needed
Device injects intramuscularly or subcutaneously, delivers the naloxone, and retracts the needle fully into its housing
Needle not visible before, during, or after
Key Point: Benefits of intranasal naloxone

9. Auto-injector Naloxone
Practice with the Trainer to make sure you are able to safely use the auto-injector in an emergency
The Trainer does not contain a needle or medicine
It can be reused to practice your injection
The red safety guard can be removed and replaced on the Trainer
Key Point: Benefits of intranasal naloxone

10. Give Naloxone: Auto-injector
Review how to put together naloxone kit.
Interactive: have participants put together demo naloxone kits

11. Give Naloxone: Auto-injector
Review how to put together naloxone kit.
Interactive: have participants put together demo naloxone kits

12. Give Naloxone: Auto-injector
Review how to put together naloxone kit.
Interactive: have participants put together demo naloxone kits

13. Give Naloxone: Auto-injector
Review how to put together naloxone kit.
Interactive: have participants put together demo naloxone kits

14. How does a person respond to Naloxone?
Scenarios:
Gradually improves breathing and becomes responsive within 3 – 5 minutes
Immediately improves breathing, responsive, and is in withdrawal
Starts breathing within 3 – 5 minutes but remains unresponsive
Does not respond to first dose and naloxone must be repeated in 3 – 5 minutes (keep rescue breathing)
Very often those who become responsive won’t immediately realize they just overdosed

15. After Administering Naloxone
Continue rescue breathing with 1 breath every 5 seconds until emergency responders arrive
After 3-5 minutes, if the patient is still unresponsive with slow or no breathing, administer another dose of naloxone
Key Point: Continue rescue breathing, if still unresponsive and EMS has not arrived administer second dose of naloxone after 3-5 minutes

16. If victim is breathing, but unresponsive place in recovery position
If for any reason the victim needs to be left along place in recovery position

17. Naloxone Storage Intranasal: Storage between 59 degrees to 86 degrees.
Avoid extremes in temperatures for long periods of time
Replace every 6-12 months, before expiration date
Auto-injector: 59°F to 77°F (15°C to 25°C)
Temperature excursions are permitted between 39°F and 104°F
Keep in outer case until needed
If solution through viewing window is discolored, cloudy, then replace
Replace before expiration date
Keeping inventory is important. Narcan has month shelf life
Storage in recommended temperatures is important