# BLS naloxone: 4 mg nasal spray

Use the preloaded 4 mg NARCAN device for suspected opioid overdose under SO-B-002.

Population: See source criteria. Scope: BLS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: Final implementation October 1, 2017.
Canonical page: https://www.ocmedic.com/guides/bls-naloxone/
Official source: [SO-B-002 — Naloxone Administration](https://www.ochealthinfo.com/sites/hca/files/import/data/files/69065.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Product-specific pathway

- This guide covers the preloaded 4 mg nasal product on equipped BLS units. The 2 mg atomizer method has different instructions in SO-B-002.
- Anticipate agitation, withdrawal, or vomiting. If CPR is unnecessary and positioning permits, use the left lateral position to reduce aspiration risk.

## Source documents

- [SO-B-002 — Naloxone Administration](https://www.ochealthinfo.com/sites/hca/files/import/data/files/69065.pdf)

## Check & support breathing

1. Confirm ALS is responding. Use PPE and attempt stimulation.
2. Suspect opioid exposure from history or the scene, with poor responsiveness and slow/shallow breathing, or unresponsiveness without breathing.
3. Provide BVM ventilation or CPR as appropriate. For the medication pathway below, a pulse is present but response to stimulation and breathing are inadequate.

## Use the 4 mg device

1. Administer the full preloaded 4 mg dose into one nostril.
2. If breathing or consciousness improves only partially, the source permits another 4 mg dose into the opposite nostril.
3. Continue checking breathing and consciousness. Maintain airway support, prepare transport, and await ALS.

## Reassessment & positioning

- Observe breathing and consciousness after treatment. If improvement is inadequate, continue BVM ventilation or CPR as indicated by the assessment rather than waiting for naloxone to work.
- When CPR is unnecessary and positioning allows, the source recommends the left lateral position to reduce aspiration risk. Watch for agitation, abdominal cramping, sweating, or vomiting.

## Keep the product and scope clear

- SO-B-002 also describes a 2 mg syringe-and-atomizer option, split between nostrils, with a separate repeat instruction. That is not the same device as the 4 mg preloaded spray.
- The ALS medication guide uses separate doses and repeat intervals. Record the device strength, doses already given, response, and the continuing need for ALS care.