Check before giving

SO-B-002 is a separate BLS pathway for stocked equipment, including a 4 mg preloaded spray and a 2 mg atomizer method. Do not transfer ALS repeat-dose rules into the BLS instructions.
Anticipate vomiting, agitation, and withdrawal after reversal. Continue airway and respiratory reassessment.

Use in OCEMS

The ALS overdose pathway treats suspected opioid toxicity with respiratory depression, approximately 12 breaths/min or fewer.
Support ventilation with BVM and suction as needed while treating the suspected cause.

Indication / route	Dose & limits
ALS IV	0.4–1 mg IV; repeat every 3 minutes as needed to maintain adequate breathing.
ALS IM / IN solution	0.8, 1, or 2 mg IM/IN; repeat every 3 minutes as needed.
Preloaded nasal product	I-15 directs the preloaded dose, repeating every 3 minutes as needed. Inventory 325.00 lists 4 mg/0.1 mL and optional 8 mg/0.1 mL products; verify the actual device and agency protocol.

SO-P-085: 0.1 mg/kg IN/IM/IV, maximum 1 mg per dose; repeat every 3 minutes as needed. It separately lists a preloaded 4 mg/0.1 mL nasal spray.
Use the condition order’s maximum and the correct concentration; do not assume all prefilled or intranasal products have the same dose.

Source: SO-P-085. Dose rule: 0.1 mg/kg; route: IN/IM/IV.
0.1 mg/kg IN/IM/IV, maximum 1 mg per dose; may repeat every 3 minutes as needed. Ventilation support comes first.
The separate 4 mg/0.1 mL preloaded nasal spray is a fixed single-spray product. Do not use the syringe volumes below for that device.
I-20 lists a rounded 0.8 mg dose for some 0.4 mg/mL product bands; these examples instead calculate the SO-P-085 0.1 mg/kg regimen with its 1 mg cap. Confirm the actual product and applicable order.
Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.

Exact weight	Dose — IN/IM/IV	Volume at 1 mg/mL	Volume at 0.8 mg/2 mL = 0.4 mg/mL
3 kg	0.3 mg	0.3 mL	0.75 mL
4 kg	0.4 mg	0.4 mL	1 mL
5 kg	0.5 mg	0.5 mL	1.25 mL
6 kg	0.6 mg	0.6 mL	1.5 mL
8 kg	0.8 mg	0.8 mL	2 mL
10 kg	1 mg	1 mL	2.5 mL
12 kg	1 mg	1 mL	2.5 mL
15 kg	1 mg	1 mL	2.5 mL
20 kg	1 mg	1 mL	2.5 mL
25 kg	1 mg	1 mL	2.5 mL
30 kg	1 mg	1 mL	2.5 mL
35 kg	1 mg	1 mL	2.5 mL
40 kg	1 mg	1 mL	2.5 mL
45 kg	1 mg	1 mL	2.5 mL
50 kg	1 mg	1 mL	2.5 mL
60 kg	1 mg	1 mL	2.5 mL

For a nasal device, confirm product strength and follow that device’s instructions. For drawn-up solutions, verify mg/mL before selecting volume.
Document respiratory response, repeated doses, and prior bystander administration; prepare transport and further ALS care.