FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Suspected opioid toxicity with respiratory depression under the ALS or separate BLS pathway. Continue ventilation support.
Contraindications & local exclusions
- The cited naloxone injection label excludes hypersensitivity to naloxone or other product ingredients. Check the label for the actual nasal spray or injection; products and BLS/ALS instructions differ.
Precautions
- Recurrent respiratory depression can follow initial improvement. Abrupt withdrawal, vomiting and agitation can occur, including in opioid-dependent neonates. Continue reassessment and use the matching repeat-dose pathway.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
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.
Adult / adolescent
| 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. |
Pediatric
- 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.
Pediatric weight table — Suspected opioid toxicity with respiratory depression
- SO-P-085 pediatric dose: 0.1 mg/kg 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 |
Preparation & reassessment
- 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.
UNDERSTAND THE CARE
Why the product name is not enough for a dose history
Naloxone is supplied in products with different strengths and delivery methods. A report of “one spray” or “one syringe” is incomplete until the actual device is identified. Ask about bystander administration and retain that treatment in the handoff and repeat-dose decision.
Applying the guidance
For drawn-up solutions, use the correct concentration and condition-specific pediatric cap. Fixed preloaded nasal devices do not use the syringe-volume table. Continue airway and ventilation support and reassess respiratory effort and consciousness after each dose. Improvement may be partial, and subsequent monitoring must look for recurrent respiratory depression and treatment-related vomiting or agitation.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Breathing
- Provide needed ventilatory support.
- Product
- Syringe solution or fixed nasal device.
- History
- Include prior doses and time.
- Reassessment
- Breathing, recurrence, vomiting and consciousness.
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.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- I-20 — Pediatric Medication Volume Dose by Weight
- SO-M-050 — Substance Overdose / Poisoning - Adult / Adolescent
- SO-P-085 — Substance Overdose / Poisoning - Pediatric
- SO-B-002 — Naloxone Administration
- 325.00 — Advanced Life Support (ALS) Provider Unit Minimum Inventory
- Product label — NALOXONE HYDROCHLORIDE injection
- Name / formulation reference — Medication name and formulation terminology
Document breathing before and after each intervention
The treatment record should show what happened to breathing, not merely whether the patient became more awake. Record the initial respiratory findings, the ventilation assistance provided, the naloxone product and dose, and the reassessment. Continue the matching overdose pathway when the response is incomplete or breathing worsens again.
For example, a bystander reports giving a nasal spray before EMS arrival. Ask for the package or product name, administration time and number of devices used. Preserve that treatment history even when a different EMS preparation is selected. “One spray” does not identify the strength, and a fixed nasal device is not a syringe-volume calculation.
At handoff, describe the trend in respiratory effort and consciousness, the timing of assisted ventilation, all known doses and any vomiting or agitation. If prior treatment cannot be confirmed, report it as uncertain. Do not interpret a temporary improvement as evidence that monitoring or assessment for other causes of altered mental status is complete.
Source: Substance Overdose / Poisoning - Adult / Adolescent.