>What is the current feeling about the practice of giving IM as well as IV
>narcan (naloxone) to opiate abusers when they arrive in A&E?
>
>Andy
--->The logic behind this approach is not as unsound as some have suggested.
The idea: Give IM Naloxone first, in case IV dose wakes patient up so much
that they get up and vamoose, then collapse.
Th problem: IM route unpredicatble and definitely shorter half life than at
least some opiates, e.g. Methadone, so problem delayed, not solved.
But: If you are to have a patient abscond on you, you have less of a chance
of them rebounding with the IM dose than without. Statistical, but definite
advantage.
Solutions:
1. For most of us, best approach is slow and gradual IV titration to restore
adequate ABC's. Patient will still be drowsy and require close observation,
but when this eventually wears off it will be due to opiates being out of
the system.
2. In some overseas departments there is a policy to restrain all 4 limbs
before waking patient up - I personally don't like this.
3. Best option - Natrexone and then, of course, the whole issue is
irrelevant.
Must say, have been using option 1. without abscondees for many years now.
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