PMID- 23347721
OWN - NLM
STAT- MEDLINE
DCOM- 20130429
LR  - 20131121
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Linking)
VI  - 31
IP  - 3
DP  - 2013 Mar
TI  - Use and efficacy of nebulized naloxone in patients with suspected opioid 
      intoxication.
PG  - 585-8
LID - S0735-6757(12)00528-1 [pii]
LID - 10.1016/j.ajem.2012.10.004 [doi]
AB  - OBJECTIVE: To describe the use and efficacy of nebulized naloxone in patients 
      with suspected opioid intoxication. METHODS: This was an observational study 
      conducted at an inner city emergency department. Patients were eligible if they 
      had self-reported or suspected opioid intoxication and a spontaneous respiratory 
      rate >/=6 breaths/minute. Nebulized naloxone (2 mg in 3 mL normal saline) was 
      administered through a standard face mask at the discretion of the treating 
      physician. Structured data collection included demographics, vital signs pre and 
      post naloxone administration and adverse events. The primary outcome was level of 
      consciousness, which was recorded pre and 15 minutes postnaloxone administration 
      using the Glasgow Coma Scale (GCS) and the Richmond Agitation Sedation Scale 
      (RASS). RESULTS: Of the 73 patients who presented with suspected opioid 
      intoxication and were given naloxone over the study period, 26 were initially 
      treated with nebulized naloxone. After nebulized naloxone administration, median 
      GCS improved from 11 [interquartile range (IQR) 3.5] to 13 (IQR, 2.5), P = .001. 
      Median RASS improved from -3.0 (IQR, -1.0) to -2.0 (IQR, -1.5), P < .0001. Need 
      for supplemental oxygen decreased from 81% to 50%, P = .03. Vital signs did not 
      differ pre/post therapy. There were few adverse effects from nebulized naloxone 
      administration: 12% experienced moderate-severe agitation, 8% were diaphoretic 
      and none vomited. Eleven required subsequent administrations of naloxone, nine of 
      whom self-reported using either heroin, methadone or both. Of these, 5 underwent 
      urine drug screening and all 5 tested positive for either opiates or methadone. 
      CONCLUSIONS: Nebulized naloxone was well-tolerated and led to a reduction in the 
      need for supplemental oxygen as well as improved median GCS and RASS scores in 
      patients with suspected opioid intoxication.
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Baumann, Brigitte M
AU  - Baumann BM
AD  - Department of Emergency Medicine, Cooper Medical School of Rowan University, 
      Camden, NJ 08103, USA. baumann-b@cooperhealth.edu
FAU - Patterson, Rachel A
AU  - Patterson RA
FAU - Parone, Dominic A
AU  - Parone DA
FAU - Jones, Molly K
AU  - Jones MK
FAU - Glaspey, Lindsey J
AU  - Glaspey LJ
FAU - Thompson, Nicole M
AU  - Thompson NM
FAU - Stauss, Mary P
AU  - Stauss MP
FAU - Haroz, Rachel
AU  - Haroz R
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20130121
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Narcotic Antagonists)
RN  - 36B82AMQ7N (Naloxone)
SB  - IM
MH  - Administration, Inhalation
MH  - Adolescent
MH  - Adult
MH  - Analgesics, Opioid/*poisoning
MH  - Drug Overdose/*drug therapy
MH  - Glasgow Coma Scale
MH  - Humans
MH  - Middle Aged
MH  - Naloxone/*administration & dosage/therapeutic use
MH  - Narcotic Antagonists/*administration & dosage/therapeutic use
MH  - Pilot Projects
MH  - Prospective Studies
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2013/01/26 06:00
MHDA- 2013/04/30 06:00
CRDT- 2013/01/26 06:00
PHST- 2012/08/23 00:00 [received]
PHST- 2012/10/03 00:00 [revised]
PHST- 2012/10/03 00:00 [accepted]
PHST- 2013/01/26 06:00 [entrez]
PHST- 2013/01/26 06:00 [pubmed]
PHST- 2013/04/30 06:00 [medline]
AID - S0735-6757(12)00528-1 [pii]
AID - 10.1016/j.ajem.2012.10.004 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2013 Mar;31(3):585-8. doi: 10.1016/j.ajem.2012.10.004. Epub 2013 
      Jan 21.