Narcan question.

[NomadicMedic]

I've never been prouder of you, young Padawan. LOL

Thanks. That made my day.

 

[46Young]

When deciding to use narcan, conventional thought is to titrate to respirations. Along with other clinical findings, a good way to do this is to use quantitative ETCO2 capnography.

You can titrate to resps. If you give too much, they wake up too quickly, and risk vomiting or a withdrawal Sz, along with having to deal with a now violent combative pt. You can use small increments, such as 0.2-0.4 mg as mentioned earlier. Narcotics can outlast narcan, so capnography can be used to determine if the narcan is wearing off.

It's also a good idea to use capnography for pts that receive narcotics or sedation as well.

 

[46Young]

To add to my last post, hypoventilation secondary to an opiate OD can present as a normal RR w/ a low tidal volume, not just a low RR alone.

 

[Smash]

I have noticed alot of reluctance to giving narcan in quite a few of the threads and I was just wondering the reasoning behind this. I don't know if I am missing something. I know in my MCA we use narcan all of the time and I have never seen nor heard of any problems from its use other than, vomiting and combativness. I'm a new medic and just want to be sure im getting it all down pat. Thanks.

The issue is not the use of narcan. It is the use of narcan because the provider is too dumb, or lazy to be bothered working out what is wrong with the patient and forming an appropriate treatment plan. I have seen comments on this site like "pinpoint pupils are enough, give the narcan" or words to that effect. If the patient needs narcan, I give them some. In fact, for over a decade we have been using a highly successful treat and release program, treating dozens, and at times hundreds of heroin overdoses across the service every week. But not every opiate overdose needs narcan, and not every respiratory depressed patient is an opiate overdose.

So no, I'm not afraid of narcan. I'm afraid of substandard clinicians practising cookbook medicine.

 

[durac]

In my system the administration of Narcan is more respiratory driven ... usually dependant on SpO2 and capnography, not necessarily LOC. 0.4 mg - 2 mg starting bolus but i go up by 0.2 mg slow IVP increments.. if you've waken someone up too fast or seen someone else do it youll understand why

 

[rmabrey]

The biggest problem locally is some doctors chew medics out for giving narcan, and other doctors chew them out for not giving it. So generally the choice is made dependent on what doctors are on duty that day. Sad but true

Sent from my Desire HD using Tapatalk

 

[themooingdawg]

our protocol uses either for hypoventilation or suspected narcotic od, so it can kind of go both ways, but i mean its one of those drugs that yeah, unless you're really thinking its narcotic od, pinpoint pupils, hx of opiate use, track marks, environment situations, then use it, but i would try and assess for other things first before putting in the narcan, unless it warrants immediate use

 

[themooingdawg]

but ya, when i give it, i definitely titrate it to effect

 

[bigdogems]

When deciding to use narcan, conventional thought is to titrate to respirations. Along with other clinical findings, a good way to do this is to use quantitative ETCO2 capnography.

You can titrate to resps. If you give too much, they wake up too quickly, and risk vomiting or a withdrawal Sz, along with having to deal with a now violent combative pt. You can use small increments, such as 0.2-0.4 mg as mentioned earlier. Narcotics can outlast narcan, so capnography can be used to determine if the narcan is wearing off.

It's also a good idea to use capnography for pts that receive narcotics or sedation as well.

I thought I was going to be the first to bring up Capno
Of course you follow your local protocols but in general if someone has a good SPO2 and Capno is within normal range with good wave forms Im not going to give narcan even if they're unresponsive with pinpoint pupils. As brought up in previous posts there is the possibility of other drugs on board. There is no point in waking them up just to have to put them back down again with a benzo. As said I look at tidal volume as well. Not just rate.

In a recent study they took several people and had them sit and read for a half hour while they read. The average rate was around 8/min. Not greatly scientific my any means just some food for thought

 

[mycrofft]

MICP, good one.

Someone mentioned endogenous opioids as mood regulators. I was just reading Temple Grandin's book (Animals in Translation) and she cites studies where suppressing endorphins in otherwise unaffected animals will cause them to become more aggressive. Maybe we potentiate "rage upon awakening" by slamming Narcan into someone whose endorphin balance is whack, causing them to swing the other way. Be kind of hard to study, I think.

 

[MedicPatriot]

See, I always TRY to titrate but they always completely wake up even after .4mg slow. The only time I really give the full 2mg is if its IM or Nasal. I haven't used the nasal atomizer on a patient yet but at least I won't have to stick a heroin addict. I hear it works decent.

I have no fear of giving Narcan at all so I don't know why people say that. OTOH I don't give the old "cocktail" just bc someone is unconscious. I had a unconscious heroin addict today I didn't give Narcan and someone asked why not. Well his pupils were fine, RR fine, and maybe because he was unconscious due to a head injury and NOT from heroin? Lol.

 

[usafmedic45]

Be kind of hard to study, I think.

Another reason I want to go take a dump on the grave of Sigmund Rascher and into the box containing the bones of Josef Mengele.

 

[usalsfyre]

See, I always TRY to titrate but they always completely wake up even after .4mg slow.

So give 0.2mgs. There's no one saying you can't give less than 0.4mgs. Or give it IM. Understanding the medication beyond a drug card is actually pretty essential to doing this job well.

I have no fear of giving Narcan at all so I don't know why people say that.

Because other people have sufficient education and experince to know the bad things that can happen. The longer I'm a medic and the more I perform certain procedures the more they scare me. Doesn't mean I don't perform them, but a hefty dose of caution has been added.