FIELD REFERENCE
Full criteria & treatment guidance
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.
Check & support breathing
- Confirm ALS is responding. Use PPE and attempt stimulation.
- Suspect opioid exposure from history or the scene, with poor responsiveness and slow/shallow breathing, or unresponsiveness without breathing.
- 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
- Administer the full preloaded 4 mg dose into one nostril.
- If breathing or consciousness improves only partially, give another 4 mg dose into the opposite nostril.
- 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, place the patient in 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.
VISUAL FIELD REFERENCE
4 mg nasal naloxone: support breathing throughout
Adult and pediatric per OCEMS criteria · BLS
Suspected opioid exposure with inadequate responsiveness and breathing. Product-specific BLS pathway.
Confirm ALS response and support breathing
Confirm ALS is responding. Use PPE and attempt stimulation.
Provide BVM ventilation or CPR as appropriate. For the medication pathway below, a pulse is present but response to stimulation and breathing are inadequate.
- One nostril
Use the preloaded 4 mg device
Administer the full preloaded 4 mg dose into one nostril.
- Opposite nostril
Partial improvement
If breathing or consciousness improves only partially, give another 4 mg dose into the opposite nostril.
Continue assessment and airway support
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.
- 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.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-B-002
UNDERSTAND THE CARE
Why ventilation and product identification come first
The medication step fits a patient with a pulse and inadequate responsiveness and breathing in a suspected opioid exposure. The initial assessment still determines whether the patient instead needs CPR or other immediate support. Naloxone administration should be integrated with ongoing airway and ventilation care rather than treated as a pause in those tasks.
Applying the guidance
The preloaded spray, syringe-and-atomizer technique and ALS medication pathways are different instructions. Identify the actual device and any doses given by bystanders before preparing the next intervention. After administration, watch breathing and consciousness together and prepare for vomiting, agitation or incomplete improvement. Pass the product strength, time and response to ALS.
Putting it together
Teaching example: a bystander says “one Narcan” was given. Obtain the device or packaging when possible, clarify the time, continue breathing support and communicate what is known and what remains uncertain.
Diagram text & teaching checkpoints
- Assess
- Pulse, responsiveness and breathing.
- Support
- BVM or CPR according to assessment.
- Identify
- Use the exact preloaded nasal-product pathway.
- Reassess
- Breathing, consciousness, vomiting and ALS handoff.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.