Hey guys! Today's video is all about naloxone. We're going to talk about how Narcan,
this life-saving medication that's inside here, is easily accessible to you but more importantly,
we're going to show you what's inside this kit, how to use it , and how it actually works
in the body so you have an understanding as to what's going on when we use Narcan
Welcome back my name is Tammy and this is NurseMinder and on this channel we do
everything nursing so if you're new here consider subscribing below so that you get the
next video when it is released. 0kay so naloxone, the generic name so it's always with a little n,
or Narcan, the brand name has the capital n, this is an opioid antagonist which means
it will reverse the effects of opioids in the body and so in order to understand what the antagonist
does let's take a step back and see what an opioid is and does. Now opioids are often prescribed for
pain but we also know that they are available on the street and so you may recognize names such as
fentanyl, that's a huge one on the street, morphine, oxycodone, hydromorphone.Those
are all medications we want to make sure that people are not overdosing on because
not only does it get rid of the pain but it decreases their drive to breathe. So how
does an opioid work? Every cell has particular receptors and let's just say this is my opioid
and this is floating along here in the blood, it recognizes that it fits in this receptor,
snugs right in there, and this will change the function of the cell.
Now we have opioid receptors throughout the body - they're in the brain, and the brain stem,
in the spinal cord, and even in our intestines. I mean one of the most common side effects that
people who take opioids complain about is constipation and so when the opioids bind
to those receptor sites in the intestine they slow down motility. But it's the receptor sites
in the brain stem that are actually causing us the troubles with a decreased drive to breathe. Every
cell has unique receptors that will alter the function of that cell and when the opioid floating
through the bloodstream happens to land and fit into that receptor, it changes the function,
which in this case if it's in the it's in the spinal cord in your peripheral nervous system
it will bind and it decreases the pain signaling up to the brain. That's awesome! But we also
happen to have receptors in the brain stem which is going to decrease breathing and so what happens
is when the receptor site comes here in the brain stem it sends a signal to the body to slow
down breathing. Now depending on how much opioid the patient has on board and how naive they are to
medications, we may or may not see this happen right away. So the question is how does Narcan
work and why would we give this to reverse an opioid? I'm going to show you. We're going to
say that this colorful one is my Narcan. Consider Narcan to be like the bully in the playground,
although this is a really good bully. He comes along and Narcan has a really strong affinity
for the same receptor site as our opioid receptor and what that means is when it sees that receptor
site it wants it and it's going to fight harder for it. So when Narcan comes into the bloodstream
and it happens to come across opioid it's going to bump it out and it will sit in there. It takes
its seat inside the receptor site and then that signal to change the cell's function has stopped
and it will continue to go back to its normal functioning. So what does this mean for our
patients? Our patients will wake up with a bang and if they had a lot of pain it will all come
back. Let me tell you a story. Now the first time I experienced the actual use of Narcan, I was
working as an emergency room nurse in downtown Winnipeg and we diagnosed this patient who had
just come in as an opioid overdose. We're going to give Narcan to to really rule in our diagnosis.
At that time only one dose of narcan was needed to rule in or rule out, things have definitely
changed since I started nursing and now you might give multiple doses of Narcan before you get the
response I'm going to share with you. But as they're preparing the Narcan, and I actually
don't recall, I don't think I gave it, I think I was just like witnessing the whole event,
they gave the Narcan and the other nurses, I think there's three of them in this bay with
me because this is a patient who's unresponsive and their respiratory drive is down so there's
a lot of us working with her, they happen to just step outside the bay and it wasn't far,
I mean this is an emergency room. There's the bay across the hall, they're just standing right there
and I was so excited and I remember thinking oh my god this is gonna be so exciting I've read about
this. I can't wait to see how this works. Well it wasn't as awesome as I thought it would be,
it was a little bit more terrifying actually. So they gave the Narcan, stepped out, and in - and it
works quickly - within seconds this patient sits right up out of bed, she's cursing, she's cussing,
she wants to get out of bed, she's fighting to get away, like she doesn't know where the hell she is
first of all and I did the only thing that I knew of in that moment and I jumped on top of her and
I was like holding her down and I'm looking at my peers and I'm like are you coming back? Because I
am like freaking out in this moment and I remember thinking they did not tell me that in this book.
They didn't say that the patient would be angry and hostile and try to get out
of their bed and that I'd have to like jump on top of them. I was not prepared for this.
And so they must have obviously came back in because we had to keep her safe but that moment
of using Narcan for the first time was quite traumatic. So I share that with you because
if you're in the community and you give Narcan, first of all as I mentioned before it used to
be only one dose and if we got a response that validated that it was an opioid overdose and we
could rule out every other cause, so we could rule out stroke, we could rule out seizure,
we could rule out hypovolemia, low blood pressure, and all sorts of other things,
and if it didn't work we would start looking at other reasons as to why this person's
unresponsive. Is it a tumor? is it electrolytes? is it sugars? but fast forward to today's world,
one dose is no longer diagnostic and in fact we're giving two and three and four doses before we even
get our first response because the drugs are so much stronger now. Uh that it's taking an awful
lot more Narcan to actually have that impact. so I shared that story with you because if your patient
does respond I don't want you to be freaked out because remember they took that medication for
a reason - likely to get rid of their pain and now we've just taken that all away from them,
stripped it away, and they're waking up often in a place that they're not familiar with,
they're not sure how they got there, but more importantly all their pain is back and they are
not happy. Now that being said I have worked with some street outreach nurses who have had
very different experiences and that sometimes the patients will wake up and say thank you and
they are appreciative because they know the risks they have their Narcan kit with them
and they also know that if utilized this is what's going to happen and so this particular
nurse has had some amazing stories. I wish that for you. But be prepared for the crazy.
So let's take a look at what's inside this kit. Now when we first open up our kit
you're going to notice that there are two compartments: on one side we've got a pair
of gloves there's also an airway device so that should your patient be in need of resuscitation
You have your own airway here to provide rescue breathing safely. There's also your prevention
kit and it will give you instructions here on how to use everything that's in here
and it gives a little bit more information about things such as the recovery position
and some alcohol swabs on the other side we have three vials,
you're always given three doses of Narcan or naloxone,
each vial is a complete dose and there is 0.4 milligrams per one ml and in this one,
we're going to give it - well we have the option of giving it through intravenous, intramuscular,
or subcutaneous. so in the community, we're going to give it by intramuscular injection,
and then you want to check the expiry date and this one is expired this is
actually the test kit that I teach people with okay so there are three of these
and then you're going to have are your needles
of which there are three.
now some kits will have the nasal the nasal spray, others may have already pre-filled
auto-injectors but if you have this kit I want to just talk to you about how to go ahead and draw up
your medication. You're going to take an alcohol swab you want to clean the tip of this off first
I like to leave my alcohol swab on there until I'm ready
and take out your needle. I'll just move this out of the way so we're just focusing on
the needle. Okay, then you want to take off the cap
and that exposes the needle we're going to just draw up a little bit of air
and we will insert it into the rubber stopper here, INSERT THE AIR,
turning it upside down to allow the fluid to come down to the bottom and make sure your tip
comes near the edge, you can see your tip inside of there, let's see if we can get that for you-
not too hard to see - then you'll withdraw all the fluid that's in here.
All right so what's going to happen is you're going to see that there's a mix of medication and
air and we need to get rid of the air, so we want to just push it you can see the air moving up,
and then you're going to see a little bleb here.
I know my medication is ready. So we'll pretend this is my patient's leg, you simply just inject
it straight in and push that plunger. Okay so just to recap that when you draw up if you need to drop
the full 1 ml of Narcan which is 0.4 milligrams - that's one dose. You're going to administer
it at a 90 degree angle into a large muscle so into the shoulder or into the thigh. Now
how many doses are you going to give?Well if you get a response with the first one we know it's
going to last anywhere between 15 - 20 minutes initially to about an hour and that's really
dependent on how much drug is on board for the patient and how naive they are and what we mean
by that is is this the first time they've taken it because they may have responded really strongly or
they may not have responded hardly at all, so that will also impact how quickly they recover and stay
awake. Now after that time frame if they start to fall back asleep on you, because they likely will,
it will take more than one dose, that's when you're going to administer dose number two.
boom boom Again they're going to bolt up, they're not going to be happy with you,
they'll stay awake for a while and if they start to drift off again and become unresponsive you
give dose number three. You're given a total of three doses in the community and hopefully by then
your EMS has arrived. Now if you've given the first dose and there's no response you can go
ahead and give the second dose at a two to three minute intervals and then you can give the third
dose at a two to three minute interval again if there's no response. You will not harm anybody if
you give multiple doses because all it's doing is looking for that one receptor site and it's
going to sit in there that's all it's going to do and that receptor site just restores the cell to
normal function. So if the cell wasn't unhealthy nothing will change. Okay now in your kit you
have a total of three doses at 0.4 milligrams so there's a total of 1.2 milligrams that you can
administer. The nurse's drug guide says that if you've given 10 milligrams to a patient and they
still have not responded to Narcan than to start looking at is this really an opiate overdose?
There may be something else going on. So where should you get these kits and why should you have
one? These kits are available at pharmacies free of charge, you just go in, no questions asked. And
you should have one if you have any prescription narcotics in your house because you never know
what people are going to get into. The other people or other group of people who should have
this are those who are using drugs recreationally as you don't always know what's in the medication.
You don't know how balanced the the mixture is, you don't know if it's laced with something else,
and so this would be handy to have on you at all times if you're going to participate in
recreational drugs and let people know you have it that way they can get it if you need support.
Now there is a caveat in terms of the medication in here, it does have to stay at room temperature
so you don't want to leave this in your car in the hot summer or in the freezing winter,
make sure you bring it in with you everywhere you go. So that's it for our Narcan lesson. Go over to
your pharmacy and grab one, you can even have it just for an emergency that you carry with you in
case you ever need to respond. Stay safe everybody and until next time make it a great day :)