Try to focus on the topic you raised, Narcan, your disdain for U.S. EMS is obvious, and I am on board with the need to revamp the educational requirements.
Certainly,
Permit me to quote part of my original post?
Now I know it is popular to pull out the anecdotes and the "what if's," but really, how often does your service use sodium bicarb? Mag sulfate? Atropine? (which makes me wonder why people would use it to "poison" a stable patient to improve some numbers, that have grossly overinflated safety ranges.)
I sort of singled out medications in this post, but it is not limited to that.
Now the point of this post isn't to pick on EMS or accuse it of negligence or substandard practice, but really. You have providers performing treatments that are often not needed, then turning around and not providing treatments in most cases that are!
Look at the cost to maintain a quality intubation program compared to the benefits of intubation.
At which point in my first reply the only mention of narcan:
I was thinking that the point of narc reversal is to stabilize respiratory and vascular systems. Anesthesia never seems to use narcan, titrated or otherwise, and they give narc doses far in excess of EMS on a daily basis. One of the most common heard mantra of ALS providers is they are not afraid of narcs because they can reverse them, which of course, seems like flawed clinical judgement.
You suggest that the idea you can give narcan should be the reason not to withold analgesia?
all the way down in post 18:
Later this evening I expect to look up the exact physiological and pathophys of both opioid OD and the reversal of it to really see whether or not there is a flaw in the original theory of its use for EMS.
next time i mentioned narcan, right after you decided your argument was to put me in my place as a student :
It depends on a couple of factors.
1. Are providers titrating it appropriately?
2. Are they using it punitively?
3. Are they doing it for patient benefit or their convienience?
4. If less aggresive treatment achieves the same thing, what makes acute reversal the treatment of choice?
5. What is the sequele if you induce irretractable pain or acute opioid withdrawel doing it? Is it worth that?
Next was a question about my choice of education. Probably because that was the only response you could dream up after your initial attempt an an insult didn't work.
Honestly my first choice of school was the oldest in the Western world, my wife asked me if I would consider something closer to her home and i thought given her sacrifice it was the least I could do. But looking back I do not regret my decision to come to this school and I am rather proud of it. Especially when I see what is coming out of the US schools.
Tell me, Other than trying to coatail greater minds as demonstration of your greatness What exactly is your contribution?
somewhere in there, USA responded to a treatment question:
"Fluids, suction, an NPA and BVM?"
My next reply to narcan was the search I did on it.
So how far off topic am I?
