Question: Can there be some consideration to an inclusion of a (1mg-2mg) Naloxone standing order for VSA patients from a suspected opioid overdose as per current literature and practice?

 When looking at modifications to the Cardiac Arrest Protocols, the AHA Guidelines released in 2010 are used as the reference point. In Part 12: Cardiac Arrest in Special Situations (Vanden Hoek et al 2010 page S840), it specifically states:

"There are no data to support the use of specific antidotes in the setting of cardiac arrest due to opioid overdose. Resuscitation from cardiac arrest should follow standard BLS and ACLS algorithms. Naloxone is a potent antagonist of the binding of opioid medications to their receptors in the brain and spinal cord. Administration of naloxone can reverse central nervous system and respiratory depression caused by opioid overdose. Naloxone has no role in the management of cardiac arrest."

Based upon these international consensus guidelines, it is unclear that current literature and practice supports the routine use of naloxone for cardiac arrest from suspected opioid toxicity. If you are familiar with literature reflecting a different conclusion, the SWORBHP Medical Council would be happy to review it.

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Narcan, Vital Signs Absent (VSA)

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