Narcan can now be administered by everyone in Ca.

[exodus]

http://www.kcra.com/heroin-antidote.../-/rxw8r6z/-/index.html#.UvCJ7-VNAl4.facebook

Makes me wonder if basics will be allowed to administer it while working.

 

[chaz90]

Based on the rest of what I read about the plight of many EMTs in CA, I'd guess not. Perhaps you can follow AHA recommendations to the letter and immediately "call for help" (to a bystander in this case) when you get on scene of an opiate OD.

I kid. Mostly

 

[CentralCalEMT]

Ah, yes California, the state that would not let EMTs use AEDs, won't give paramedics RSI even with additional training and home to such "progressive" EMS systems such as Orange County wants to give laypeople an emergency drug.

Considering basics just got permission to use AEDs while on duty, I am gonna guess that it will take about a decade for narcan to appear on BLS ambulances.

That being said, I have serious reservations about this law. I highly doubt the friends/family administering narcan will also notify EMS. IV drug users seem to be scared of any vehicle with flashing lights and not just cop cars. Therefore, you will have a lot of OD patients thinking they are OK and then, when the narcan wears off, go into respiratory arrest and die. Naturally, the article fails to mention what we all know, that the effects of opiates far outlast the effects of narcan.

Also with the random crap most heroin is cut with, you never know exactly what the patient took. Compounding this issue, many drug users use multiple drugs, and have other chronic health problems from years of drug use such as diabetes, seizures or any other conditions that can cause ALOC and/or respiratory depression. Whats not to say that they are in respiratory arrest from some other cause? I can imagine the delay calling EMS when the heroin user stops breathing because of airway obstruction from a seizure who does not get the help he needs because his friends are messing around with giving him narcan and 20 min later when he is still unresponsive they finally decide to call EMS.

 

[SandpitMedic]

....
Considering basics just got permission to use AEDs while on duty, I am gonna guess that it will take about a decade for narcan to appear on BLS ambulances.

I was a basic in CA back in 2008-2011.... And we were trained and allowed (in fact mandated) to use the AED if needed.

That was both in Central NorCal and San Berdo Counties.

Also, narcan doesn't take 20 minutes to work.

As for the stuff I bolded- that's just EMS. We're slow to evolve, that's part of our problem gaining speed.

 

[mycrofft]

Yes you can use it on the job….if you're a heroin addict.:rofl:

AED"s are tricker because you can't use them in a moving vehicle unless you stop every two minutes for "Analyzing"...

 

[TheLocalMedic]

Is Narcan a lifesaving drug? Absolutely.

Should EMTs be allowed to carry and administer it? Heck yeah.

Is there any good argument against EMTs having it? Nope.

…

So will we let them have it then? Probably not. That would be just too logical.

 

[Carlos Danger]

Good stuff.

I have long thought nalaxone should be an OTC drug.

 

[mycrofft]

http://reference.medscape.com/drug/narcan-naloxone-343741#4
"Adverse Effects
Frequency Not Defined
Withdrawal reaction precipitated

Abrupt reversal of narcotic depression may result in nausea, vomiting, sweating, tachycardia, increased blood pressure and tremulousness

Cardiac arrest

Ventricular fibrillation

Dyspnea

Pulmonary edema"

MEDSCAPE attributes these to opioid withdrawl syndrome. In my experience,:censored:but without nalozone, very rare. Otherwise , they basically call it mother's milk, and in fact states it's not known if it affects lactation.

Slippery slope giving drugs to techs otherwise not trained in them and then expecting them to titrate it to effect.

 

[Carlos Danger]

http://reference.medscape.com/drug/narcan-naloxone-343741#4
"Adverse Effects
Frequency Not Defined
Withdrawal reaction precipitated

Abrupt reversal of narcotic depression may result in nausea, vomiting, sweating, tachycardia, increased blood pressure and tremulousness

Cardiac arrest

Ventricular fibrillation

Dyspnea

Pulmonary edema"

MEDSCAPE attributes these to opioid withdrawl syndrome. In my experience,:censored:but without nalozone, very rare. Otherwise , they basically call it mother's milk, and in fact states it's not known if it affects lactation.

Slippery slope giving drugs to techs otherwise not trained in them and then expecting them to titrate it to effect.

Does it really make sense to not administer an antidote to a dying person because the antidote may have some negative side effects?

 

[NomadicMedic]

Here in Delaware, a trial program to allow EMT basics to administer Narcan is ongoing. The only problem is I foresee are; EMTs giving a CVA or other altered patient 2 mg of Narcan and then waiting around to see what happens, or administering 2 mg of Narcan up a heroin addicts nose and then getting their butts kicked. both of those will be good learning experiences, and I bet they'll only happen once or twice.

 

[CentralCalEMT]

I was a basic in CA back in 2008-2011.... And we were trained and allowed (in fact mandated) to use the AED if needed.

That was both in Central NorCal and San Berdo Counties.

Also, narcan doesn't take 20 minutes to work.

As for the stuff I bolded- that's just EMS. We're slow to evolve, that's part of our problem gaining speed.

Yeah I was referring to good old LA county which still has BLS ambulances without AED. I'm happy most counties aren't quite so far behind the times.

 

[SandpitMedic]

Lol the county with "advanced scope" doesn't allow the use of AEDs?!
What a joke. Wowza!

 

[SandpitMedic]

Perfect timing for this though- considering the Phillip Seymour Hoffman thing.

 

[mycrofft]

Good question.

Does it really make sense to not administer an antidote to a dying person because the antidote may have some negative side effects?

Asking the question supplies the answer. "Do no (further) harm".

They will not allow laypersons to legally get and administer enough narcan to help in many cases. (So, often futile).

Some places already and illicitly slip narcan to their addicted clients, but one news article I head said they don't know if it is doing any good. (Suggests it is futile).

If you are convinced what you are going to do pharmaceutically (no matter how thin the chance of it working and no matter how thin your absolute knowledge of the drug) ought to be done because "I gotta do SOMETHING!" (to do nothing is distressing to you), then you are one foot in the Malpractice Hole and sliding towards killing or harming someone.

There are three questions here:

1. Is it ethical and safe (forget legal for the moment) to do this?

2. Is it realistic to expect it to help, based in scientific evidence and experience? Or will we see gross misdosaging, calls for 911 delayed because "We gave him the narcan, dude!", and incorporation of narcan into abuse patterns rather than as curative (such as medical O2 getting highjacked for hangovers enabling alcohol abuse).

3. Historically "antidotes" and "harmless drugs" (look up the history of the medicinal uses of thalidomide, radium salts, and strychnine) aren't. Should people without depth in background in assessment, care and pharmacodynamics be given antidote drugs to administer on the basis that a "panacea dose" (not tailored to pt weight and dose of poison) will save lives? IS there a "panacea dose", or do we just blast everyone with a high (pun untintended) dose? And remember, this is medicine being held and given by junkies, maybe often by people under the influence at the time.

 

[mycrofft]

Just found this

http://www.drugs.com/pro/narcan.html *


AND I QUOTE:

"Overdosage

There is limited clinical experience with Narcan overdosage in humans.

Adult Patients

In one small study, volunteers who received 24 mg/70 kg did not demonstrate toxicity. In another study, 36 patients with acute stroke received a loading dose of 4 mg/kg (10 mg/m2/min) of Narcan followed immediately by 2 mg/kg/hr for 24 hours. Twenty-three patients experienced adverse events associated with naloxone use, and naloxone was discontinued in seven patients because of adverse effects. The most serious adverse events were: seizures (2 patients), severe hypertension (1), and hypotension and/or bradycardia (3).

At doses of 2 mg/kg in normal subjects, cognitive impairment and behavioral symptoms, including irritability, anxiety, tension, suspiciousness, sadness, difficulty concentrating, and lack of appetite have been reported. In addition, somatic symptoms, including dizziness, heaviness, sweating, nausea, and stomachaches were also reported. Although complete information is not available, behavioral symptoms were reported to often persist for 2-3 days."

So, crappy science or no science of ill effects, but some are suggested by a very small study (why on CVA patients?).

* This article was headed by an ad asking "Want to detox at home?". Kid you NOT!

 

[SandpitMedic]

Asking the question supplies the answer. "Do no (further) harm".

They will not allow laypersons to legally get and administer enough narcan to help in many cases. (So, often futile).

Some places already and illicitly slip narcan to their addicted clients, but one news article I head said they don't know if it is doing any good. (Suggests it is futile).

If you are convinced what you are going to do pharmaceutically (no matter how thin the chance of it working and no matter how thin your absolute knowledge of the drug) ought to be done because "I gotta do SOMETHING!" (to do nothing is distressing to you), then you are one foot in the Malpractice Hole and sliding towards killing or harming someone.

There are three questions here:

1. Is it ethical and safe (forget legal for the moment) to do this?

2. Is it realistic to expect it to help, based in scientific evidence and experience? Or will we see gross misdosaging, calls for 911 delayed because "We gave him the narcan, dude!", and incorporation of narcan into abuse patterns rather than as curative (such as medical O2 getting highjacked for hangovers enabling alcohol abuse).

3. Historically "antidotes" and "harmless drugs" (look up the history of the medicinal uses of thalidomide, radium salts, and strychnine) aren't. Should people without depth in background in assessment, care and pharmacodynamics be given antidote drugs to administer on the basis that a "panacea dose" (not tailored to pt weight and dose of poison) will save lives? IS there a "panacea dose", or do we just blast everyone with a high (pun untintended) dose? And remember, this is medicine being held and given by junkies, maybe often by people under the influence at the time.

These are the right questions. And very well stated.

 

[TheLocalMedic]

 

[mycrofft]

 

[SandpitMedic]

Exactly.- the pictures!

And that's the truth. Satire aside.

You're looking at what will happen. People (generally our clientele) can't even handle NyQuil, yet were sitting here debating giving them Narcan.

Jeeze. Rogue media circus.

 

[TheLocalMedic]

DEAR LORD, HERE I AM AGAIN, ASKIN' ONE MORE CHANCE FOR A SINNER!

[EXPLICIT]

http://www.youtube.com/watch?v=CXJ8c0rWJsk