Narcan

T

trauma1534

Forum Captain
Messages
309
Reaction score
3
Points
0
I am curious as to how different providers would handle this. You have a methidone overdose. Or with any overdose for that matter... which would you do and why? This particular patient was 40yom, resp. 4, unresponsive.

A. Give enough narcan to increase resp drive, transport

B. Intubate, give some narcan

C. Don't intubate, give narcan and wake up patient, transport (tx done enroute)
 
Give Narcan get refusal signed go back base and go to bed. :lol:


Not really but is good for a laugh. I would give enough Narcan to improve respitory rate then transport and keep an eye on resp. rate and keep it around 12 to 14. You have to remember that sometimes the overdose is done in an attempt to kill themselves so you have to be careful when wakeing them up.
 
Our new medical director just had a discussion in regards to this question. i agree with him, just enough to improve respiratory drive.

Recent studies have demonstrated seizures and sudden withdraw symptoms are being more and more reported by standard dose of 2 mg. Titration doses of 0.4mg SIVP, and watch effects of respiratory is the main purpose. If you notice increase respiratory drive, then you know your etiology and Dx. and one does not need to supercede.

There are so many patients nowadays that are on narcotics, and diazepam type directives, one may not be aware of. Sudden withdraw with seizures, will be difficult to control after administering antagonist medications.

R/r 911
 
I, too, would have to agree with the others here. If you give them more than enough needed to increase repiratory effort and improve SPO2 you run the risk of the seizures, as well as having a full blown fight in the back of the little white box.
 
while enroute:
just enough to increase and stabalize resp drive.

immediatley upon arrival at recieving H(still in rig in lot):
enough to wake em up, ruin the best high of their life, piss em off. then you walk in, point to the nurse you dont like and say" she did it"
 
I would go with anser A. Just enough to increase resps. A BLS airway is temporarily acceptable if it provides O2 for perfusion. I wouldn't feel to bad if they woke up but no need to fight with them or make them puke.

There are very few occurances of a PT going into withdrawl and then into v-fib but only when too much Narcan is pushed too fast. It's rare but documented.
 
Do you know upfront that it is a methadone OD, or is this what you find out after the fact? Like being dispatched to a "unresponsive male." The reason I ask is because with resps that slow and no history to go on, this guy buys a tube until I can do a better exam. Our med control would eat me alive for not tubing this guy, securing the airway first. After finding out this was an OD then we could extubate and narcan him, depending on the doc's feeling at that second and whether the planets had aligned as he wished, but you know how that goes. But eliminating all of the "what ifs" I would go with titrating narcan to respiratory drive (answer A)
 
DITTO:excl:
 
oldschoolmedic said:
Do you know upfront that it is a methadone OD, or is this what you find out after the fact? Like being dispatched to a "unresponsive male." The reason I ask is because with resps that slow and no history to go on, this guy buys a tube until I can do a better exam. Our med control would eat me alive for not tubing this guy, securing the airway first. After finding out this was an OD then we could extubate and narcan him, depending on the doc's feeling at that second and whether the planets had aligned as he wished, but you know how that goes. But eliminating all of the "what ifs" I would go with titrating narcan to respiratory drive (answer A)
Click to expand...

I'd have to ask: have you done this? Tubed and then gave narcan? Really it's a great textbook answer but does't work in reality. You give the narcan first, it's fast and easy, then you KNOW what the problem is. It's harmless enough at a dose less than 2 mg and sure is a lot better for everyone.

I've worked at a couple of services over the last 20 years and it's always been a standing type order, so the medical control is not even involved until down the road.

But of course I understand every place is different.
 
oldschoolmedic said:
Do you know upfront that it is a methadone OD, or is this what you find out after the fact? Like being dispatched to a "unresponsive male." The reason I ask is because with resps that slow and no history to go on, this guy buys a tube until I can do a better exam. Our med control would eat me alive for not tubing this guy, securing the airway first. After finding out this was an OD then we could extubate and narcan him, depending on the doc's feeling at that second and whether the planets had aligned as he wished, but you know how that goes. But eliminating all of the "what ifs" I would go with titrating narcan to respiratory drive (answer A)
Click to expand...

I disagree with intubating initially also. Treat the etiology not the symptoms. As well, now you have a person that awakens on a vent (traumatic event)... and now you either can will have to extubate (which is also traumatic).
K I S S Keep it safe and simple.. one should be able to control an airway for at least 3 minutes and ventilate properly until Narcan can be administered to increase respiratory drive.

R/r 911
 
I can't tell you what I would really do, yall would laugh at me...oh well...you know me though...you can about imagine.
 
This was a known meth od.

Fed, really what would you do? LOL
 
Last edited by a moderator:
I'd titrate narcan to effect, ie: normal resp. rate. For the first few minutes, I'd have my partner ventilate the patient correctly with a BVM and perhaps an airway (probably nasal). As their respiratory drive comes back, switch them over to 100% O2 by NRBM and transport. Make sure your IV is taped down well in case they wake up and are unhappy.

If you tube the guy, he wakes up and tries to yank the tube - BAD
If you give 2mg of Narcan and wake the guy up suddenly - BAD
If you feel like being a PITA to the patient and are burned out, and sick of the skells who take a little too much heroin - give 2mg IM, then 2mg IVP - that wakes them up and keeps them up, for a while... (this is REALLY BAD... don't do this) - this is how Philly FD EMS put it to me.
 
Last edited by a moderator:
what about... tube them... start the line, give them enough narcan to wake them up, then extubate them, get them to sign your refusal, if they won't sign, then get PD to witness, then you are back in service=back on the couch=down time!!! Sound good??? lol
 
Sounds good to me!.. as long as they can make it alive until post shift change...LOL

R/r 911
 
My concern is that there isn't always a field extubation protocol.
 
trauma1534 said:
what about... tube them... start the line, give them enough narcan to wake them up, then extubate them, get them to sign your refusal, if they won't sign, then get PD to witness, then you are back in service=back on the couch=down time!!! Sound good??? lol
Click to expand...


You forgot saving the taxpayers money. So we can put more trucks on the road and give us more down time.
 
You must log in or register to reply here.
Back
Top