I had an odd situation and would like some input.

voodoomedic90

voodoomedic90

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I responded for a 74 yom, unk hx found down in the bathroom. He has pin point, sluggish, pupils, depressed respirations at approx. 8 times per minute. We give 2mg of Narcan IN because he has horrid veins. We finally obtain a 22g IV in his L. Hand. We give another 2mg Narcan slow IVP. He responds to the Narcan and improves from a GCS 3 to a GCS about an 8. We arrive to the ED and give report to charge RN. The attending physician over hears bits of the pt as we talk to the RN. He asks me to get at temp. I get a temp of 99.1 apical. He turns and states that pts that are septic also respond Narcan. The pt did appear to be someone who has a chronic illness, like cancer or an autoimmune disease. He is prescribe numerous narcotic based medications. He has very thin skin which has retracted into the body. I have done tons of research on this and I can find nothing that supports this statement made by the doctor. Has anyone ever heard of this before?
 
I've never heard of this, but a quick search on Google Scholar (sepsis and naloxone), turned up a few results.

One very small study showed naloxone increased systolic blood pressure in septic patients. If true, that could account for the increased GCS of your patient. It looked like there were a few other small studies, but it's a pain in the *** to pull them up on my phone.
 
While I can't speak on what the doc said, you said he's prescribed several narcotic pain meds. Even if he's altered because of the sepsis, knocking out his usual pain meds with narcan will increase his GCS just by means of painful stimuli.

Edit: STX, is this what you found?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2625808/

Narcan in septic shock increasing the MAP by 20-30.

Just out of curiosity, what were his vitals before and after?
 
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Correct. Only 13 patients, and 25 years old. If I remember, I'll dig more when I have real access.
 
Occam's Razor says he took an extra dose of his usual pain meds by accident (or on purpose) and that's why he responded to Narcan? Maybe not, though - that study is interesting!
 
Hickam's Dictum says F you, he's septic too. ;)
 
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