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Intravenous vs Subcutaneous Naloxone for Out‐of‐hospital Management of Presumed Opioid Overdose
Author(s) -
Wanger Karen,
Brough Laura,
Macmillan Ian,
Goulding Jim,
MacPhail Iain,
Christenson James M.
Publication year - 1998
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1998.tb02707.x
Subject(s) - medicine , (+) naloxone , anesthesia , respiratory rate , opioid overdose , opioid , ventilation (architecture) , drug overdose , poison control , heart rate , emergency medicine , blood pressure , mechanical engineering , receptor , engineering
ABSTRACT Objective : To determine whether naloxone administered IV to out‐of‐hospital patients with suspected opioid overdose would have a more rapid therapeutic onset than naloxone given subcutaneously (SQ). Methods : A prospective, sequential, observational cohort study of 196 consecutive patients with suspected opioid overdose was conducted in an urban out‐of‐hospital setting, comparing time intervals from arrival at the patient's side to development of a respiratory rate ≥10 breaths/min, and durations of bag‐valve‐mask ventilation. Subjects received either naloxone 0.4 mg IV ( n = 74) or naloxone 0.8 mg SQ ( n = 122), for respiratory depression of <10 breaths/min. Results : Mean interval from crew arrival to respiratory rate ≥ 10 breaths/min was 9.3 ± 4.2 min for the IV group vs 9.6 ± 4.58 min for the SQ group (95% CI of the difference ‐1.55, 1.00). Mean duration of bag‐valve‐mask ventilation was 8.1 ± 6.0 min for the IV group vs 9.1 ± 4.8 min for the SQ group. Cost of materials for administering naloxone 0.4 mg IV was $12.30/patient, compared with $10.70/patient for naloxone 0.8 mg SQ. Conclusion : There was no clinical difference in the time interval to respiratory rate ≥10 breaths/min between naloxone 0.8 mg SQ and naloxone 0.4 mg IV for the out‐of‐hospital management of patients with suspected opioid overdose. The slower rate of absorption via the SQ route was offset by the delay in establishing an IV.