Prehospital naloxone given by nebulized inhaler
January 20, 2012, 1:03 am
Can Nebulized Naloxone Be Used Safely and Effectively By Emergency Medical Services For Suspected Opioid Overdose? Weber JM et al. Prehosp Emerg Care 2011 Dec 22 [Epub ahead of print]
Many emergency practitioners are not aware that naloxone can be given by nebulizer. In the non-emergent situation involving a patient with suspected opiate intoxication, this route has many advantages: it does not present of risk of needlestick injury to medical providers; it minimizes the chance of severe acute opiate withdrawal; and it is titratable — typically, when the patient wakes up a bit from the naloxone, he or she removes the mask.
This well-designed study — from Cook County Hospital and the Chicago Fire Department — investigated the use of nebulized naloxone in the prehospital setting. The authors retrospectively reviewed all cases in which nebulized naloxone was used by the Chicago EMS system for suspected opiate overdose, altered mental status, or respiratory depression. The protocol called for 2 mg naloxone mixed with 3 mL normal saline in patients who had spontaneous respiratory effort and stable cardiopulmonary status. The primary outcome was paramedic-documented response to naloxone treatment.
During the six month study period, 105 patients met inclusion criteria. Eighty-one percent of patients had complete or partial response to nebulized naloxone. There were no adverse events. The authors conclude that nebulized naloxone is safe and effective treatment in patients with suspected opiate overdose and spontaneous respiration.
Of course, this paper does not demonstrate that naloxone was necessary or improved ultimate outcome in many of these cases. My view is that in most non-emergent situations, naloxone can be avoided entirely. But if it is elected to give naloxone, the nebulized route is a very attractive alternative.