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Did you ever find out what this kid's deal was or are we just taking shots in the dark?
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You gave narcan because you suspected he may have taken bath salts?
not only be potentially fighting with the incredible coked-out Hulk,
That's not exactly a good reason for anything...Gave him narcan because hes laying on my stretcher unresponsive...
Acute withdrawal, seizures, pulmonary edema, unopposed sympathetic stimulation, aspiration from vomiting...Whats an adverse effect of giving narcan? He loses his "high" if he has one?
Except Narcan can also reverse Klonopin on occasion, and you haven't really ruled it out till you get a tox back, and you should probably be able to get clues about what's going on by physical assessment before blindly pushing a drug.If that was what was wrong then hey you firgured it out, if not well then you possibly ruled out a cause.
Except atropine for 3rd degree is actually be more appropriate....Its not like a gave a 3rd degree block patient atropine and wonder why they died...
A&P, pathophys and pharm are our "stock in trade" so to speak. You should consider all three before you perform any treatment. Going around blindly pushing meds because "he's laying unresponsive on my stretcher" is weak sauce.Not only because i thought he took bath salts. G
Except Narcan can also reverse Klonopin on occasion
A&P, pathophys and pharm are our "stock in trade" so to speak.
Really? I haven't heard that. Just Klonopin or other Benzos? Or Gabapentin
I agree, probably shouldnt have administered the narcan. just me personally i feel this sort of need to figure out what it is/was that made him like he is.
Eh, I wouldn't drop a 14 but a 16 might have been in the cards. When you need lines that big you need them now and you better be good at starting them. I'd rather practice on the inebriated/altered person who wont complain/remember/feel it than grandma that fell down and muffed up her hip.
Can't find the reference at the moment, let me get home and I'll see if I can dig it up.
I'm interested in seeing this reference, too. I just did some digging and couldn't find a thing.
Pupillary diameter?
A. If student was drinking or doing drugs, very likely his roomies will not cop to it.
B. Hypnosis may change behavior and mood, but not to the point of raising pulse PLUS normotensive (partial response to endogenous adrenaline:unsure:? Or is the body compensating for some other cause for loss of BP? Or is the pt just transiently angry that he was stabbed in the arm?).
C. Does "semi-combative" mean resistive (which can be a basic irritant response) or want to fight? A difference clinically as to level of consciousness.
My quarter in the pool says most likely alcohol toxicity or psychoactive drugs, maybe baseline mental illness to boot. Calm everyone down, but get to medical facility as he will need pre-arrest screening including tox screen, blood alcohol.
PS: Another quarter: temp, PE and CBC to r/o sepsis.
Pt is a 20yom that law enforcement found walking in the middle of the street in front of student dorm at around 0330.
Patient is in handcuffs standing leaning against squad car, officer relays "He is not acting right and his heart is pounding." Patient is currently awake and breathing but appears altered. He is diaphoretic, tachycardic, and is semi combative. Attempts to obtain any kind of history from him are unsuccessful.
His roommate is at scene an provides very minimal history: No past medical history, NKDA, non user of alcohol or illicit drugs.
Vitals: HR 142, Resp 22, B/P 138/72, SpO2 99% room air, D-Stick 128.
14ga IV to left AC with no response to stick, 12 lead shows sinus tach, pupils PEARL, and lung sounds clear.
While obtaining vital signs, a classmate of the patient arrives an states "They were at the pep-rally for the college earlier, that he was hypnotized by a magician and has not been acting right since then." at approximately 1500 today.
0.4mg narcan administered with no change in mental status.
Where do you go now?