NYMedic828
Forum Deputy Chief
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Hey All, somewhat new here thought id start my first thread.
I'm a new medic in NY, and had a question regarding a call that occurred at my volunteer department. I was not at the call, but a brief story was told to me from a few people.
Basically, it came in as a seizure at a local restaurant. When the crew got there, they had an agitated patient who was supposedly trying to smash the urinals in the bathroom off the walls with his bare hands. (and succeeding)
Now, in my volunteer area, the police department paid ambulance usually handle any EDP/Drunk/Drug calls unless a direct call to the fire department is made. In my paid area in the city, I am far more likely to run into this again. The only reason it occurred on a volunteer level here, is because it was reported as a seizure.
So, someone I guess at some point came to the conclusion that this man is either an EDP, or on some form of drug such as PCP.
I have no idea as to how cooperative the patient was, but apparently the paramedic on scene was able to successfully administer IN Narcan.
This is where my question arises. For a patient who is extremely agitated, no respiratory depression, and is a potential danger to himself and others, was narcan really the right move? I asked the medic who did it, (who is by no means experienced) and he figured it won't hurt him, so why not try it.
From what I know, PCP causes the psychosis at lower doses, and at high enough doses can cause sedation/analgesia and ultimately seizure activity.
That being said, my argument was that the medic should have gotten on the phone with the medical director, given a convincing story and attempted to get approval for a discretionary of 10mg of versed IM or IN. (I do not know if IM would have been safe)
I figured that whether the patient be an EDP or on psychosis inducing drugs, midazolam would not only sedate the patient, making further assessment and transport easier but also ultimately preventing any further harm to the patient or providers.
Could anyone explain what the right move is?
Little side note, in my volunteer region, Controlled Substances are very rare. We are one of maybe 5 departments out of 72 that carry them. We carry Valium, Versed and Morphine. There are absolutely no standing orders in the region for the use of them, and the likelyhood of the medical director approving such a rare occurrence without a dynamite presentation is very minimal. In the city where I work, use of controlled substances is pretty routine and more leniency is given to the providers.
I'm a new medic in NY, and had a question regarding a call that occurred at my volunteer department. I was not at the call, but a brief story was told to me from a few people.
Basically, it came in as a seizure at a local restaurant. When the crew got there, they had an agitated patient who was supposedly trying to smash the urinals in the bathroom off the walls with his bare hands. (and succeeding)
Now, in my volunteer area, the police department paid ambulance usually handle any EDP/Drunk/Drug calls unless a direct call to the fire department is made. In my paid area in the city, I am far more likely to run into this again. The only reason it occurred on a volunteer level here, is because it was reported as a seizure.
So, someone I guess at some point came to the conclusion that this man is either an EDP, or on some form of drug such as PCP.
I have no idea as to how cooperative the patient was, but apparently the paramedic on scene was able to successfully administer IN Narcan.
This is where my question arises. For a patient who is extremely agitated, no respiratory depression, and is a potential danger to himself and others, was narcan really the right move? I asked the medic who did it, (who is by no means experienced) and he figured it won't hurt him, so why not try it.
From what I know, PCP causes the psychosis at lower doses, and at high enough doses can cause sedation/analgesia and ultimately seizure activity.
That being said, my argument was that the medic should have gotten on the phone with the medical director, given a convincing story and attempted to get approval for a discretionary of 10mg of versed IM or IN. (I do not know if IM would have been safe)
I figured that whether the patient be an EDP or on psychosis inducing drugs, midazolam would not only sedate the patient, making further assessment and transport easier but also ultimately preventing any further harm to the patient or providers.
Could anyone explain what the right move is?
Little side note, in my volunteer region, Controlled Substances are very rare. We are one of maybe 5 departments out of 72 that carry them. We carry Valium, Versed and Morphine. There are absolutely no standing orders in the region for the use of them, and the likelyhood of the medical director approving such a rare occurrence without a dynamite presentation is very minimal. In the city where I work, use of controlled substances is pretty routine and more leniency is given to the providers.
