Narcan anyone???

[Jambi]

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.

Of we all know that done a certain way and documented a certain way are different things. I am, of course, in no way advocating falsifying patient documentation, but I've also known a few that have done the same; especially when a known opiate frequent flyer is known to be violent when coming out of the OD.

 

[JPINFV]

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.

Doesn't RivCo's ALS protocol start off with an awesome section about how the protocol is a guideline and that paramedics must use their own judgement when implementing it?


Edit:

Section 4101: Introduction to Treatment Protocols Page 3.
Standing Orders:
...
Standing orders are to be utilized as clinically indicated. Not every standing order in a treatment protocol must be carried out on every patient treated under that treatment protocol. Discretionary judgment is required

 

[chief]

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!!!

Talk about a dynamic job environment. Well I won't be seeing any of that action as we mostly deal with dialysis patients/pickups.....would love to be in a firehouse to get more experience such as this.

 

[DrankTheKoolaid]

Even better and something I have come across multiple times lately is the clean needle exchanges giving out narcan. So you show up to a reported OD and the patient has already been given 0.4/0.8 by their partners in crime and is still in need of more

 

[the_negro_puppy]

Do you mean 500 mcg or do you actually carry a concentration low enough that you can administer that low of a dose?

We carry 400cmg /1ml. The drug was diluted by the Intensive Care Medic assisting us to a concentration of 500mcg / 10ml I believe (we only give the drug IM by ourselves)

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

We had him on Etc02 nasal prongs once we stopped bagging him and switched him over to 02 mask.

 

[Carlos Danger]

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...

Yes. I think a narc OD where you are titrating nalaxone is one of the few times in the field that capnography can make a real difference in how you manage the patient.

Just because you use something a lot doesn't mean it is useful.

 

[Tigger]

Talk about a dynamic job environment. Well I won't be seeing any of that action as we mostly deal with dialysis patients/pickups.....would love to be in a firehouse to get more experience such as this.

Meh. That's not always how it goes down. They don't always fight, sometimes they're just wake up and they're pretty with it.

Even better and something I have come across multiple times lately is the clean needle exchanges giving out narcan. So you show up to a reported OD and the patient has already been given 0.4/0.8 by their partners in crime and is still in need of more

Most of the programs encourage the person with naloxone to call 911 if they give it. Massachusetts is a leader in this and the program has been extremely successful. It's not always a "partner in crime," giving the medication to family of known addicts has been quite effective, with the family also being far more likely to call 911. Police officers in cities and towns with addiction problems were also provided with it several years before BLS ambulances were. naloxone is a BLS standing order in MA should the service choose to carry the drug.

The information I had originally about the MA program was that the DPH was providing .4ml prefills with MAD devices for IN administration. Obviously .4 is often times not enough, but it may buy sometime before the ambulance arrives.

 

[DrankTheKoolaid]

Yeah I'm sure that is true sometimes, I just haven't seen it that way.. Yet.