ABC EMS Solutions LLC

A 2025 study published in Nature Communications compared 5 mg intramuscular (ZIMHI) to 4 mg intranasal (Narcan) naloxone in healthy opioid-naïve individuals and chronic opioid users experiencing fentanyl-induced apnea.

The study used a randomized, crossover, open-label design in a controlled clinical setting, simulating a real-world fentanyl overdose while ensuring patient safety and precise data collection.

Key findings:
- Faster Onset: IM naloxone reversed apnea in a median of 2.3 minutes, compared to 3.4 minutes with IN naloxone in opioid-naïve individuals (p = 0.002).
- Fewer Doses Required: IM reversal required a median of 1.5 doses vs. 2 doses for IN (p = 0.0002).
- More Reliable Absorption: IM naloxone produced higher peak plasma concentrations and more consistent pharmacokinetics.
- Fewer Rescue Interventions: IV rescue naloxone was needed in 0% of IM cases vs. up to 40% of IN cases in chronic opioid users.

Full story linked in comments ⬇️

Pushing an "Amp of Bicarb" should no longer be standard practice.

A new systematic review and meta-analysis looked at 126,013 out-of-hospital cardiac arrest patients and asked a simple question: Does sodium bicarbonate improve outcomes when used during cardiac arrest?

The answer: not routinely.

Across 11 studies, there was no improvement in ROSC, survival to admission, survival to discharge, or neurological outcomes when sodium bicarbonate was given as part of standard resuscitation efforts.

That doesn’t mean it has no place in EMS. It remains appropriate for hyperkalemia, tricyclic antidepressant toxicity, or profound metabolic acidosis, but routine use for undifferentiated cardiac arrest isn’t supported by current evidence.

This study reinforces something critical in prehospital medicine:
🔍 If we want to improve survival, we need high-performance CPR, early defibrillation, airway and ventilation management, and timely access to definitive care. Medications alone are not the magic bullet.

Check out the study here:https://www.handtevy.com/wp-content/uploads/2025/11/Effectiveness-of-Sodium-Bicarbonate-Administration-in-Out-of-Hospital-Cardiac-Arrests-An-Updated-Systematic-Review-and-Meta-Analysis.pdf

With better reporting on timing, dosing, ETCO₂, and airway strategy, we may learn more about when sodium bicarbonate could help, but for routine use, the science isn’t there.
Evidence matters. Protocols should evolve with it. 💙