Medication contraindications

[bdoss2006]

Generally speaking, what contraindications do you go by for meds at a BLS level? Our protocols for the most part don’t address contraindications, and just show indications. Does that mean with aspirin for example, that you give it no matter what, or do you go by something such as contraindications on pubmed?

(https://www.ncbi.nlm.nih.gov/books/NBK519032/)

 

[mgr22]

Generally speaking, what contraindications do you go by for meds at a BLS level? Our protocols for the most part don’t address contraindications, and just show indications. Does that mean with aspirin for example, that you give it no matter what, or do you go by something such as contraindications on pubmed?

(https://www.ncbi.nlm.nih.gov/books/NBK519032/)

Regarding all of your posts about the absence of protocols in your system, the problem is...wait for it...the absence of protocols in your system. That will not be resolved here.

No one with medical training will tell you to give aspirin "no matter what." That would be as foolish as deciding on your own, based solely on external sources, how you will practice within your system.

You should contact whoever runs your system for clarification. Or move to a different system. Or don't give aspirin. Or any other drugs.

 

[MMiz]

I don't think there are any absolutes when it comes to medications. Every medication has contraindications.

I would reach out to your medical control authority. My bet is that they'd get back to you the same day and be happy to answer your questions.

 

[DrParasite]

I don't think there are any absolutes when it comes to medications. Every medication has contraindications.

Except narcan.... when a a person who has ODed isn't breathing, give the medication. provided the indications are there, give the medications, regardless. The only "relative" contraindication is an allergy to nalaxone; well, we can give the patient some benedryl to deal with the itching or hives; at least they will be breathing.

 

[E tank]

Except narcan.... when a a person who has ODed isn't breathing, give the medication. provided the indications are there, give the medications, regardless. The only "relative" contraindication is an allergy to nalaxone; well, we can give the patient some benedryl to deal with the itching or hives; at least they will be breathing.

or someone that is awake and alert...

 

[NomadicMedic]

Except narcan.... when a a person who has ODed isn't breathing, give the medication. provided the indications are there, give the medications, regardless. The only "relative" contraindication is an allergy to nalaxone; well, we can give the patient some benedryl to deal with the itching or hives; at least they will be breathing.

Or who has a brain bleed, or is postictal, or is hypoglycemic. All are cases in where I’ve seen Narcan administered.

Jesus. The lack of education is staggering.

 

[MMiz]

What's with the attitudes?

I'm looking at my local protocols for overdose and I don't see any of that at the BLS level, @NomadicMedic

With Narcan doesn't the risk of death from respiratory depression outweighs other concerns?

 

[DesertMedic66]

What's with the attitudes?

I'm looking at my local protocols for overdose and I don't see any of that at the BLS level, @NomadicMedica

With Narcan doesn't the risk of death from respiratory depression outweighs other concerns?

I think he is saying more along the lines of do a good and proper assessment. Dont just think patient not breathing = narcan but rather run through our differential diagnosis and problem solve. If everything is lining up for an opiate OD then sure you can give it.

We have had some cases recently where the patient was OD on cocaine that was mixed with fentanyl. When the opiate OD was reversed the patient became extremely tachycardic and hypertensive, think 160bpm and 200/120.

 

[VentMonkey]

Or who has a brain bleed, or is postictal, or is hypoglycemic. All are cases in where I’ve seen Narcan administered.

Jesus. The lack of education is staggering.

I think he is saying more along the lines of do a good and proper assessment. Dont just think patient not breathing = narcan but rather run through our differential diagnosis and problem solve. If everything is lining up for an opiate OD then sure you can give it.

We have had some cases recently where the patient was OD on cocaine that was mixed with fentanyl. When the opiate OD was reversed the patient became extremely tachycardic and hypertensive, think 160bpm and 200/120.

@MMiz I think this what is often meant by being more of a practitioner than simply a technician.

 

[DrParasite]

or someone that is awake and alert...

That means it's not indicated, which is different from a contraindication.

Or who has a brain bleed, or is postictal, or is hypoglycemic. All are cases in where I’ve seen Narcan administered.

Jesus. The lack of education is staggering.

The attitude is uncalled for. narcan isn't indicated in a brain bleed, someone who is postictal, or hypoglycemic... It's not contraindicated, it's not indicated.

If you need to review what a contraindication is and are confusing it with administering a medication inappropriately, then I think your education (or lack thereof) is alarming. I'll even help you out with this entry from merriam-webster.com, so you don't have to look it up yourself, as your lack of education on this topic is on full display. You're welcome for the education.

I think he is saying more along the lines of do a good and proper assessment. Dont just think patient not breathing = narcan but rather run through our differential diagnosis and problem solve. If everything is lining up for an opiate OD then sure you can give it.

We have had some cases recently where the patient was OD on cocaine that was mixed with fentanyl. When the opiate OD was reversed the patient became extremely tachycardic and hypertensive, think 160bpm and 200/120.

I thought that was a given; don't give medications when they aren't indicated. If you are chasing the heroin user around the apartment to give him Narcan, then it's not indicated; that doesn't mean it's contraindicated, which would be when you shouldn't give a medication when it would otherwise be appropriate to administer.

 

[FiremanMike]

Holy **** this escalated quickly

 

[NomadicMedic]

Dupe post. Durrrrrrrrrr

 

[NomadicMedic]

It's a common issue. Narcan is often administered in situations where it isn’t indicated, such as during CVAs, hypoglycemia, or post-seizure events. This happens more frequently than it should. That's called a CONTRAindication. Here's the definition: a condition or circumstance that suggests or indicates that a particular technique or drug should not be used in the case in question.

It's well documented that there is a significant lack of education regarding the proper indications for Narcan. When I teach EMTs, I emphasize that the only indication for Narcan is respiratory depression caused by opioid use—nothing else.

 

[E tank]

Holy **** this escalated quickly

yeah...it was getting boring around here...roll with it....

 

[E tank]

Honestly, I believe it should be mandatory for providers to demonstrate competency with a BVM before being allowed to administer Narcan. Especially police officers.

The police would be the last group to claim the identifier of 'providers'. That said, if you can mask a patient, an opioid OD becomes, by definition, less of an emergency....it's precisely because BVM's are not readily accessible that narcan is...

It's well documented that there is a significant lack of education regarding the proper indications for Narcan. When I teach EMTs, I emphasize that the only indication for Narcan is respiratory depression caused by opioid use—nothing else.

This is kind of our fault..when pre hospital narcan became mainstream in the 70's and 80's the narrative was it's pretty much in the same category as 'air'. That narrative, like so many other's in medicine, persist to this day, hence the OTC nasal preparation that comes with a Big Mac and fries.....

 

[CCCSD]

I think the nasal OTC Narcan is due to the now massive amount of ODs in the US, and it’s a means of saving lives, not because we gave it to patients who needed it who were a small segment of society…

I was never taught “ Narcan is the same as air”.

I did learn that when you legalize drugs, you create more harm, not less.

 

[E tank]

I think the nasal OTC Narcan is due to the now massive amount of ODs in the US, and it’s a means of saving lives, not because we gave it to patients who needed it who were a small segment of society…

I was never taught “ Narcan is the same as air”.

I did learn that when you legalize drugs, you create more harm, not less.

Don't misunderstand my point. That OTC narcan has saved a few lives, relative to the pandemic of OD deaths in the tsunami of fentanyl coming into the country is good, as feeble a gesture as it is. There's this mentality though that therapy has no down side. The opioid dependency phenomenon began in earnest after this insane 'pain is the 5th vital sign' campaign in the early 2000's that was an absolute set up for the fentanyl trade after it inevitably was walked back. Just making a statement on the mindset that you can franchise medical therapy.

 

[DrParasite]

It's a common issue. Narcan is often administered in situations where it isn’t indicated, such as during CVAs, hypoglycemia, or post-seizure events. This happens more frequently than it should. That's called a CONTRAindication. Here's the definition: a condition or circumstance that suggests or indicates that a particular technique or drug should not be used in the case in question.

Sigh... This is another example of the lack of education in this field... we have a user who is, without a credible source, providing an inaccurate definition of a contraindication, and using that to justify his erroneous claim.

As per merriam-webster.com, the definition of a contraindication is as follows:

something (such as a symptom or condition) that makes a particular treatment or procedure inadvisable

Additional information from M-W on this topic is as follows:

For doctors, an indication is a symptom or circumstance that makes a particular medical treatment desirable. Serious anxiety, for example, is often an indication for prescribing a tranquilizer. A contraindication, then, is a symptom or condition that makes a treatment risky, such as taking certain other medications at the same time. Drugs and conditions that are contraindicated for a medication are listed on its label, and reeled off at high speed in TV ads. Patients can guard against the dangers of drug interaction by reading labels carefully and making sure their doctors know what else they're currently taking.

Just because something is not indicated doesn't mean it's contraindicated; it's just not indicated, so you shouldn't be doing it. Similarly, morphine and fentanyl are not contraindicated for a patient with the sniffles.... however, if it's not indicated, you shouldn't give it.

It's well documented that there is a significant lack of education regarding the proper indications for Narcan. When I teach EMTs, I emphasize that the only indication for Narcan is respiratory depression caused by opioid use—nothing else.

That is 100% correct... but, despite your previous erroneous claims, that doesn't mean everything else is a contraindicated, it's just not indicated. So narcan isn't indicated in stroke patients, diabetics, or seizure patients, so you shouldn't be administering it.

 

[DrParasite]

There's this mentality though that therapy has no down side.

Let's go down this rabbit hole for a minute, and discuss this topic... What's the downside? What is the negative outcome to giving narcan to a person who doesn't need it?

Let's say I narcan every unconscious patient I come across... Other than reacting with any prescribed opioids they are on (which isn't the goal, but a valid concern), will they get worse? I agree, they won't get better (as it isn't addressing the reason they are unconscious, so it's not helping), and if they are not breathing before you gave narcan, then you should be ventilating before and after, but it's not going to cause a negative reaction to the patient.

If I give narcan to every cardiac arrest, right after I give the epi, what's the downside? will the patient get deader?

if I give narcan to every person I meet, if they aren't using opioids, will they suffer any negative consequences?

To be perfectly clear, I'm not suggesting that I would, or that anyone should, but just discussing the idea that narcan has no downsides.

If I give too much narcan too fast, it can cause the patient to experience projective vomiting, and in rare cases, flash pulmonary edema (as per PubMed), but that's only if a person has opioids in their system.

Also, giving narcan is not a one and done treatment, so if people think it is, that's another issue. ventilate before and afterwards, until the victim is spontaneously breathing on their own. maybe companies should give one a face mask with one way valve with every narcan they distribute?