Journal Club
May Journal Club (2012)

Thursday, May 31
6:30 PM
400 A B Prior Health Science Library

Journal Club Vignette

You are in charge of your city's EMS system and are in charge of protocol development. Some of your medics have started complaining to you about how difficult it is to obtain IV access in the heroin overdose patients they take care of and are wondering if there is an alternative to IV narcan in the non-intubated patient. Additionally, many of the OD victims are upset and agitated after given narcan and many do not want to be transported to the hospital. The medics want to know if it is safe to allow them to sign out AMA after giving them narcan if awake, alert, and oriented.

To investigate this, the following approach is explored:

PICO Question

Population: EMS patients with heroin OD
Intervention: IM/IN Narcan
Comparison: IV Narcan
Outcome: Morbidity, Mortality


Search Strategy: Pubmed; Keywords: EMS and Narcan Score Results: 25 articles. 3 selected for review:
Article 1: Vilke GM, Sloane C, Smith AM, Chan TC: Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport. (Pub Med link) Acad Emerg Med 2003 10:8 p893-6.

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Article 2: Robertson TM, Hendey GW, Stroh G, Shalit M: Intranasal naloxone is a viable alternative to intravenous naloxone for prehospital narcotic overdose. (Pub Med link) Prehosp Emerg Care 2009 13:4 p512-5.

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Article 3: Kerr D, Kelly AM, Dietze P, Jolley D, Barge: Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. (Pub Med link) Addiction 2009 104:12 p2067-74.

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First article no review sheet to complete.
Sceond article no review sheet to complete.
Third article no review sheet to complete.


Extra Articles:Sporer KA, Kral AH: Prescription naloxone: a novel approach to heroin overdose prevention. (Pub Med link) Ann Emerg Med 2007 49:2 p172-7.

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Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA: Commonly prescribed medications and potential false-positive urine drug screens. (Pub Med link) Am J Health Syst Pharm 2010 67:16 p1344-50.

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