ERDoc
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Should we use Narcan on all CPR calls?
- Thread starter RobertAlfanoNJEMT
- Start date
VentMonkey
Family Guy
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With that said, is this something you still advocate for, and/ or implement in this specific group of cardiac arrest patients, Doc?
I now seem to be the one who's genuinely curious
.DesertMedic66
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I saw the study a little while ago. So 15 out of 36 patients had EKG changes after Narcan. 47% of the 15 (so 7) had changed immediately after the Narcan was given
Critmedic had a podcast with this exact study here is his take. https://www.critmedic.com/podcasts/episode-14-when-narcan-nar-cant/
Keep in mind all were pronounced except one which doesn't sound promising and some of them died in the hospital setting. There were two where there was no follow up. Justify the cost benefit analysis? Can we make a definitive conclusion with this limited data? More studies may be needed before a quality answer is reached.
Keep in mind all were pronounced except one which doesn't sound promising and some of them died in the hospital setting. There were two where there was no follow up. Justify the cost benefit analysis? Can we make a definitive conclusion with this limited data? More studies may be needed before a quality answer is reached.
Bullets
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I think we should just give every unconscious patient an amp of dextrose, 0.2mg flumazenil, 2mg narcan and 100mg of thiamine
There was a time, not to long ago, that we dealt with overdoses with a BVM and people woke up on the way to the ER. If the patient is in arrest, good ventilation will counter the opiod
There was a time, not to long ago, that we dealt with overdoses with a BVM and people woke up on the way to the ER. If the patient is in arrest, good ventilation will counter the opiod
NomadicMedic
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Everybody gets the coma cocktail!
VentMonkey
Family Guy
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Let's not forget the Calcium Chlordie and Bicarb in spite of checking downtimes, and/ or serious suspicious for hyperkalemia in said cardiac arrest patients (RF patients anyone?)
NomadicMedic
I know a guy who knows a guy.
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Why not chuck a gram of mag in there too?
VentMonkey
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I may have to dust off the ol' Biophone for that one. Too much thinking makes my head hurt.
EpiEMS
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That's just Sunday brunch, my good sir!
In all seriousness, naloxone for everyone is the kind of thing that gets EMS treated as the red-headed stepchild at the healthcare table.
ERDoc
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I think the idea is that more studies need to be done and the meds have to be given to the correct pt population. Giving narcan to a 99y/o cardiac arrest would not be the correct pt. The 20 or 30 something with known access to opiates, maybe we would see a difference if we could get a big enough sample size. My personal sample size is low and all were given narcan prior to arrival in the ER but I have not had any survivors. However, anecdote doesn't equal evidence.
VentMonkey
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Awesome insight, thanks Doc!
NomadicMedic
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Hmmm... How did I miss this before? The AHA is saying we (including lay responders and BLS) should give Narcan, to anyone suspected of an opiate OD in cardiac arrest.
"Experience with treatment of patients with known or suspected opioid overdose has demonstrated that naloxone can be administered with apparent safety and effectiveness in the first aid and BLS settings. For this reason, naloxone administration by lay rescuers and HCPs is now recommended, and simplified training is being offered. In addition, a new algorithm for management of unresponsive victims with suspected opioid overdose is provided."
Highlights of the 2015 American Heart Association Guideline Updates for CPR and ECC at https://eccguidelines.heart.org/wp-...10/2015-AHA-Guidelines-Highlights-English.pdf.
"Experience with treatment of patients with known or suspected opioid overdose has demonstrated that naloxone can be administered with apparent safety and effectiveness in the first aid and BLS settings. For this reason, naloxone administration by lay rescuers and HCPs is now recommended, and simplified training is being offered. In addition, a new algorithm for management of unresponsive victims with suspected opioid overdose is provided."
Highlights of the 2015 American Heart Association Guideline Updates for CPR and ECC at https://eccguidelines.heart.org/wp-...10/2015-AHA-Guidelines-Highlights-English.pdf.
EpiEMS
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They specified that this is for patients with a pulse, but abnormal breathing, I believe.
NomadicMedic
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Actually... It's for a suspected opiate arrest, with the hedge being that the first responder may not beable to differentatte between respiratory arrest and a full cardiac arrest.
Cardiac Arrest in Patients With Known or Suspected Opioid Overdose 2015 (New): Patients with no definite pulse may be in cardiac arrest or may have an undetected weak or slow pulse. These patients should be managed as cardiac arrest patients. Standard resuscitative measures should take priority over naloxone administration, with a focus on high-quality CPR (compressions plus ventilation). It may be reasonable to administer IM or IN naloxone based on the possibility that the patient is in respiratory arrest, not in cardiac arrest. Responders should not delay access to more-advanced medical services while awaiting the patient’s response to naloxone or other interventions.
This is a better first responder algorithm.
EpiEMS
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Given the caveat (and the prioritization of CPR over naloxone administration), I suppose that makes sense.
cprted
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Without delving into the Naloxone in Cardiac Arrest discussion, what makes you think this person is in arrest secondary to a drug overdose? Just because they're on the younger side? Was there drug paraphernalia at the scene? Do they have a history of drug abuse? Were there empty pill bottles? Tract marks?
Could they be a Brugada Syndrome? PE? Undiagnosed hypertrophic cardiomyopathy? Tension Pneumo? Hemorrhagic CVA?
Could they be a Brugada Syndrome? PE? Undiagnosed hypertrophic cardiomyopathy? Tension Pneumo? Hemorrhagic CVA?
Where I worked, most younger arrests were secondary to drug overdose, especially opiates. But short of obvious signs there's really no way to know, especially since many chronic drug abusers will have other health problems.
The first flow-chart Demedic put up says this, administer Narcan per protocol, in pt with a pulse and abnormal resps. The second one he put up is a different one showing the flow-chart for a cardiac arrest with suspicion of Opiate OD.