Should we use Narcan on all CPR calls?

[Ginger care]

Oh good lord, did my wife put you up to this......listen I don't care what the problem is, I never once said it has any indication of my treatment for the patient. That's something you all assumed just because I'm not totally Gung hoe for Narcan in vending machines. For people who seem overly concerned about me judging you guys are doing nothing but judging. But yes you moron reckless driving, smoking, heroin, chainsaw juggling, cliff diving and going to slipknot concerts are idiotic things to do. However I never once said I haven't done idiotic things. Including alot from that list mentioned above. I don't think it's a bad drug I love being able to use it, makes those runs way more successful in turn making me remember why I love doing this job and feeling great about being able to help someone on need. But thinking that there couldn't possibly be any bad side to untrained and uneducated people having it can be reckless.

 

[Carlos Danger]

Oh good lord, did my wife put you up to this......listen I don't care what the problem is, I never once said it has any indication of my treatment for the patient. That's something you all assumed just because I'm not totally Gung hoe for Narcan in vending machines. For people who seem overly concerned about me judging you guys are doing nothing but judging. But yes you moron reckless driving, smoking, heroin, chainsaw juggling, cliff diving and going to slipknot concerts are idiotic things to do. However I never once said I haven't done idiotic things. Including alot from that list mentioned above. I don't think it's a bad drug I love being able to use it, makes those runs way more successful in turn making me remember why I love doing this job and feeling great about being able to help someone on need. But thinking that there couldn't possibly be any bad side to untrained and uneducated people having it can be reckless.

Calling me a moron doesn't make your arguments any more cogent.

Now you are changing your argument from the moral hazards of narcan to the safety of laypersons using it.

Try reading some research on the topic and maybe then you can discuss it intelligently.

 

[StCEMT]

But thinking that there couldn't possibly be any bad side to untrained and uneducated people having it can be reckless.

Care to elaborate?

 

[Ginger care]

Why can't it be both? Is not thinking about the consequences from all sides the very recklessness I was speaking of. How dare I have multiple points about something I belive, quick set me on fire and throw me in the river. The moral is secondary to the saftey of the issue. Ever heard of something called a "pharm party". The idea is all these kids show up and bring as many different script pills as they can, find and dump them into a giant bowl. They then decide some sort of order and proceed to all take a big handful at a time, I know you're thinking that's something idiots would do, and you'd be right. Except they don't see it that way. Because now the CVS around the corner sells Narcan, so they can just take that and be fine. Probably thinking "well that's only good for opiates and who knows what all they are taking". But see they don't know that, these are the same kids who think that handfuls of unknown contradicting drugs are a good way to kick back. You think they are going to listen past "a drug that can save you from dying when you are overdosing" enough to know exactly what it does and how it works everytime. And even if it was only opiates, if you don't know the dose how can you know if the amount of narcotics won't outlast the Narcan, and they think there better so no one tells the parents because who wants to get yelled at, and then they die because they don't know what they're doing. Because even aspirin while over the counter isn't idiot proof. I know it seems crazy but the sad reality is it's really not that far out there. If I have it and am allowed to use it I'm going to. But for you to assume that I'm a bad clinician or a bad person just because I don't have a bleeding heart for heroin addicts is wrong. I would never bring my personal opinions on a run, thought it was still OK to have them just like the rest of you. If I was in here talking about how I think giving someone with tension pneumo a CPAP is a good idea I would understand you jumping up my *** about it because its universally a terrible idea that would kill someone, but this is ridiculous.

 

[VentMonkey]

@Ginger care I have zero idea where you're going with your rants, but what about this:

Exactly how well "trained", or "educated" is that cop or EMR who blindly pushes Narcan on a "suspected OD" regardless of the suspected drug of choice? Is this any better than John Q. Opium buying Narcan for their nightly "fix"?

Same first responders show up to a polypharm party (yes, we all know what that is) and nasal spray any, and every suspected unconscious person at said party, is this any better? Yes? No? Why, or why not?

 

[StCEMT]

It probably would be a false sense of security for some. If they are gonna die anyway, then what's it matter whether or not they have the Narcan?

 

[Ginger care]

I get what your saying, it's a fair point and I mean that I'm not trying to be a ****. But I guess I would rather have a emr or a cop that has had even minimal training but specific to stressful situations do it than a 16 year old kid freaking out because he thinks I'm dying and can't think clearly. Also it can take up to 3 minutes to counteract the narcs, so does that kid getting a straight D minus average who couldn't care less about life know rescue breathing? Sorry I'm done ranting, I just think when people say that it has no downside it's not being thought through enough.

 

[Ginger care]

Wow I ****ed that up bad, alright I'm done.

 

[CALEMT]

Wow I ****ed that up bad, alright I'm done.

Do you even know clinically why narcan would be used? Or what like the 1 major indication is to administer narcan is?

 

[DrParasite]

@Ginger care I have zero idea where you're going with your rants, but what about this:

Exactly how well "trained", or "educated" is that cop or EMR who blindly pushes Narcan on a "suspected OD" regardless of the suspected drug of choice? Is this any better than John Q. Opium buying Narcan for their nightly "fix"?

what are the downsides to this? No wait, let me clarrify: other than the cost of the medication, or the false safety net, what will the negative patient outcome be for the patient? Or are there any negative side affects, other than it won't work?

Same first responders show up to a polypharm party (yes, we all know what that is) and nasal spray any, and every suspected unconscious person at said party, is this any better? Yes? No? Why, or why not?

Same question: if they aren't breathing, and they have taken some other drug, what will the downside be?

 

[DrParasite]

A couple of years ago, me and this paramedic who I used to work with got into an argument on Facebook about the BLS use of Narcan. Her argument was that EMTs cannot and should not be trusted with Narcan. But she was completely in favor of cops giving Narcan to reverse ODs. And the studies supported the idea that public access to narcan saves lives (I want to say the study was done in Boston, but it's been a few years).

Suffice it to say, faced with hard facts, published studies, and the fact that giving Narcan to a person who hasn't taken opioids won't have a negative consequence, he personal bias to a level of training that only two years prior she was at would not let her admit that the data did not support her objection.

So my personal opinion is this: if a drug is given over the counter, there is not reason why any EMS person should not be able to administer it. Especially if it helps with a life threatening condition (don't get me started on how certain states won't allow EMTs to give baby aspirin for possible MI patients).

Back to the OP, I think we all can agree that giving Narcan WILL NOT restart a person's heart, WILL NOT end the CPR call, and WILL NOT fix the issue at hand. However, assuming you get the person's heart started, you will still have the issues of the opiods in their system, depressing their respiratory drive, correct? and while yes, this can be resolved using a BVM, wouldn't it be better for their body if they were breathing on their own?

 

[VentMonkey]

what are the downsides to this? No wait, let me clarrify: other than the cost of the medication, or the false safety net, what will the negative patient outcome be for the patient? Or are there any negative side affects, other than it won't work?

Same question: if they aren't breathing, and they have taken some other drug, what will the downside be?

I think you're missing the point entirely. Why don't you read the entire thread from beginning to end?

And good for you for winning an argument on Facebook (shrugs)?

 

[Handsome Robb]

Sent from my iPhone using Tapatalk

 

[EpiEMS]

But thinking that there couldn't possibly be any bad side to untrained and uneducated people having it can be reckless.

Practically speaking, there is really very little evidence that there is a potential harm to expanding access to naloxone. Yes, perhaps the availability of naloxone might induce *some* users to continue using, but the number of people who might very well be "saved", if you will, exceeds that by orders of magnitude.

 

[NysEms2117]

I say this very rarely, but @Ginger care I truly think I have lost IQ points reading your posts. You struggle to portray a valid point, and you called somebody with an unmeasurable amount of intelligence(as compared to you) and idiot. I fully agree with @Remi and @NomadicMedic. You shouldn't be in civil service if you judge people like that.

 

[DrParasite]

I think you're missing the point entirely. Why don't you read the entire thread from beginning to end?

no, I read it from start to finish..... I see your point, but your point doesn't negate my question....

And good for you for winning an argument on Facebook (shrugs)?

I think you're missing the point entirely. Why don't you do review the studies on how beneficial public access narcan is?

And more importantly, why don't you answer my questions?

BTW, I agree we should give medications only if they are indicated. But if it can help the patient (even if not in the immediate situation, but in the near future), why not?

 

[EpiEMS]

Back to the OP, I think we all can agree that giving Narcan WILL NOT restart a person's heart, WILL NOT end the CPR call, and WILL NOT fix the issue at hand. However, assuming you get the person's heart started, you will still have the issues of the opiods in their system, depressing their respiratory drive, correct? and while yes, this can be resolved using a BVM, wouldn't it be better for their body if they were breathing on their own?

Hold on a sec, if the cardiac arrest is secondary to an OD, why are we using resources to do something other than what we know works (CPR and defibrillation)?

 

[DrParasite]

Hold on a sec, if the cardiac arrest is secondary to an OD, why are we using resources to do something other than what we know works (CPR and defibrillation)?

because once we get the heart started again, the body will still need to deal with the effects of the OD, which very likely caused the cardiac arrest. if you don't treat the OD, it's very likely to reoccur. and if we have extra hands to do some IN naloxone, while doing CPR and defib, is that really a bad thing?

 

[cprted]

because once we get the heart started again, the body will still need to deal with the effects of the OD, which very likely caused the cardiac arrest. if you don't treat the OD, it's very likely to reoccur. and if we have extra hands to do some IN naloxone, while doing CPR and defib, is that really a bad thing?

The cause of the arrest is hypoxia secondary to respiratory arrest. If you gets ROSC, the opiate won't cause them to rearrest unless you stop ventilating them.

Their problem is hypoxemia, not hyponarcanemia.

 

[CALEMT]

Hold on a sec, if the cardiac arrest is secondary to an OD, why are we using resources to do something other than what we know works (CPR and defibrillation)?

It certainly won't help the secondary issue. Like you said high quality cpr and early defibrillation are proven for a full arrest. However, if you gain ROSC and your patient starts to breathe on their own you'll want something to block the receptors that opiants bind to. That's where narcan comes into play.