Date Published

April 20, 2020

Updated For

ALS PCS Version ALS PCS Version 5.2


*UPDATED* Question: Regarding the removal of "inability to ventilate" consideration for narcan. In a pt who fails the covid screening, and who has overdosed on opiates, spontaneous resp rate <8, low says. Are we to withhold BVM and apply hi-flo mask at 8L and give narcan? Or use BVM as usual to assist ventilations prior to narcan administration. Its the use of the BVM in this pt that is the question


You are correct that BVM should be reserved only for those patients in cardiac arrest.  In the situation that you describe, you would use a high concentration/low flow mask with hydrophobic submicron filter, along with administration of naloxone (SC/IM/IV routes).


As of May 8, 2020, the latest release of the OBHG Recommendations (here) suggests Withholding manual ventilation in any spontaneously breathing patient unless severe hypoxia (Sp02 <85%) is not improving with other therapies

So, in the situation that you describe, you would utilize naloxone and any necessary BLS airway maneuvers, if Sp02 still <85%, move on to manual ventilation while preparing for the second dose of naloxone.




Additional Resources

No additional resources are available for this SWORBHP Tip.