Narcan anyone???

TheLocalMedic said:
Da fuq? I hope you aren't for real. That's messed up man. If you're so worried about them refusing, then just cut your dosage way down so that they're breathing but still dopey, then you can take them out of there no problem.

Intubating an OD without trying narcan??? I bet you backboard anyone over 60 just to see them squirm too... :angry:
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Actually no, I hate backboarding people, especially the elderly.
 
Are you still just a student? If so, bring that up in class and see how that goes over with your instructor.
 
Yeah. Intubating an opiate OD just because you don't want a refusal (or for just about any reason) is pretty ridiculous. So much so that I'm hoping that was just a trolling comment.
 
rmabrey said:
Meh, its cool, but I prefer to just intubate them. Ive seen one to many OD's refuse after waking up.
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What is your thought process behind this? why is them refusing a bad thing? there are services that treat and release these pts.
 
I need to ask this, don't laugh at me.

Is it pronounced nah-LOX-on,

or

NAL-ax-on
 
We always give it IM here unless there is serious respiratory depression, makes for a slower adjustment back into the reality of heroin withdrawl.
 
chief said:
So I just found out I got hired at First Response in Chicago and am currently studying their SOP's. I came across something I never heard in their SOP's called Narcan. Never came across in my EMT book but it's supposedly common in the field. Supposedly, this reverses any effects of opiates or narcotics within minutes!!! Has anyone here ever used this first hand on a drug addict and did it pop them out of their high as quick as it says it does? Thanks for any responses!

Taqee
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Give it to the in slow icrements. You want to increase their respiratory rate but let them stay unresponsive. If giving 2 mg give it to them in 0.4 mg. increments at a minute each. When their respiratory rate is adequate,STOP giving the Narcan. Capnography is perfect for this scenario!!

I have had a female patient who had overdosed on hydromorphone (dilaudud) who woke up after the first 0.4 mg, ripped out her IV and went nuts in the unit. It looked like a war zone.. THEY WILL GO NUTS ON YOU IF YOU WAKE THEM UP!!!
 
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TheLocalMedic said:
Wow, so apparently no heroin or oxy abuse in Australia eh? Here we're seeing more and more teens turning to straight up heroin after starting with oxy use.

http://www.youtube.com/watch?feature=player_detailpage&v=CXJ8c0rWJsk
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I spoke to soon. Gave 1.6mg IM Narcan (800mcg followed bys econd dose about 2 mins later) recently to a GCS 3 RR6 cyanosed OD on oxys and oral MS with no change after 10 mins of ventilation (difficult due to obese pt). Worked a treat, slowly but surely brought his GCS and resps up, topped up with 50mcg IV before transport. Was GCS14 with good resp status at hospital.
Nil combativeness, aggression or vomiting. Guy was a little annoyed asking why we didnt let him die.
 
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the_negro_puppy said:
Worked a treat, slowly but surely brought his GCS and resps up, topped up with 50mcg IV before transport.
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Do you mean 500 mcg or do you actually carry a concentration low enough that you can administer that low of a dose?
 
rmabrey said:
Meh, its cool, but I prefer to just intubate them. Ive seen one to many OD's refuse after waking up.
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I just have to agree with the others in saying that I really hope you aren't serious....

Intubation is a risky procedure that is justified only when those risks are outweighed by the benefits.

If there is no other way to secure the airway or maintain an adequate minute volume, then the benefits of intubation probably outweigh the risks. However, if you have a medication at hand that can safely reverse the respiratory depression, then opting instead to use a risky procedure is pure assault, IMO.

Many people talk about how "dangerous" nalaxone is, but frankly I think those people are dead wrong, and probably used to using toxic doses of it. I guarantee prehospital intubation causes far more problems than does prehospital administration of reasonable doses of nalaxone.

VirginiaEMT said:
Give it to the in slow icrements. You want to increase their respiratory rate but let them stay unresponsive. If giving 2 mg give it to them in 0.4 mg. increments at a minute each. When their respiratory rate is adequate,STOP giving the Narcan. Capnography is perfect for this scenario!!
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Exactly. This is one of those (relatively few, IMO) times where noninvasive capnography would be really useful.

Dilute a 0.4 mg / 1ml vial in 9 ml for a 40mcg/ml concentration, and push 1-2 cc's at a time, watching the capnograph (or chest rise, if you don't have capnography).

chaz90 said:
Do you mean 500 mcg or do you actually carry a concentration low enough that you can administer that low of a dose?
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Draw a up your entire 2 mg / 1 ml vial into a 10ml syringe and squirt half of it out. Then draw up 9.5 ml of NS so that you have 1 mg in 10 ml, or 100 mcg/ml. Push half a cc at a time = 50 mcg per dose.
 
Halothane said:
Dilute a 0.4 mg / 1ml vial in 9 ml for a 40mcg/ml concentration, and push 1-2 cc's at a time, watching the capnograph (or chest rise, if you don't have capnography).
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I was hoping someone brought this up by the time I got through the whole thread. This is exactly how I give it in the OR. The idea is to get them to breathe adequately on their own, not wake up fighting.

Not all narcotic OD's are junkies. The rapid increase in sympathetic tone caused by high-dose narcan can precipitate all sorts of problems, particularly in older sicker patients, including causing pulmonary edema and even cardiac arrest.
 
Just to add to the fun. In my county here in California, we are specifically forbidden from titrating narcan. They just let us titrate Dextrose this year, but Naran is right out (sorry monty). It's been brought up at committee meetings, and the medical director has spoken against it specifically. If we use it we must give all 2mg as a bolus or IM or IN.
 
Jambi said:
Just to add to the fun. In my county here in California, we are specifically forbidden from titrating narcan. They just let us titrate Dextrose this year, but Naran is right out (sorry monty). It's been brought up at committee meetings, and the medical director has spoken against it specifically. If we use it we must give all 2mg as a bolus or IM or IN.
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Haha are you in SSV by chance? Their protocol reads the same way and the medics who work in the system I've spoke with are all puzzled why its written that way.
 
We use naloxone in the UK. 400ug IM route or IV, titrated to effect. With experience you learn to bring them round from respiratory depression but still leaving them a bit groggy.... Makes the Patient easier to manage, providing their respiratory system is improving and no longer hypoxic. Also considered an essential drug to have with you when considering giving morphine.
 
Halothane said:
I just have to agree with the others in saying that I really hope you aren't serious....

Intubation is a risky procedure that is justified only when those risks are outweighed by the benefits.

If there is no other way to secure the airway or maintain an adequate minute volume, then the benefits of intubation probably outweigh the risks. However, if you have a medication at hand that can safely reverse the respiratory depression, then opting instead to use a risky procedure is pure assault, IMO.

Many people talk about how "dangerous" nalaxone is, but frankly I think those people are dead wrong, and probably used to using toxic doses of it. I guarantee prehospital intubation causes far more problems than does prehospital administration of reasonable doses of nalaxone.



Exactly. This is one of those (relatively few, IMO) times where noninvasive capnography would be really useful.

Dilute a 0.4 mg / 1ml vial in 9 ml for a 40mcg/ml concentration, and push 1-2 cc's at a time, watching the capnograph (or chest rise, if you don't have capnography).



Draw a up your entire 2 mg / 1 ml vial into a 10ml syringe and squirt half of it out. Then draw up 9.5 ml of NS so that you have 1 mg in 10 ml, or 100 mcg/ml. Push half a cc at a time = 50 mcg per dose.
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Few times capno is useful? We use it ALL the time, any respiratory patient or anyone that actually needs o2 will get side stream capno...
 
Corky said:
Haha are you in SSV by chance? Their protocol reads the same way and the medics who work in the system I've spoke with are all puzzled why its written that way.
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RivCo. I haven't looked at the protocols for it extremely well but I know we have a lot of medics who will titrate it.
 
Corky said:
Haha are you in SSV by chance? Their protocol reads the same way and the medics who work in the system I've spoke with are all puzzled why its written that way.
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I just read the SSV protocols... you're right. It is written that very same way. Sacramento County's expressly says to titrate to adequate respiratory effort...:blink:
 
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