Should we use Narcan on all CPR calls?

[EpiEMS]

Although the exception rather than the norm in my limited experience, my last arrest is why I don't believe in jumping straight to intubation.

It's a systemic problem for me. We have CCR in protocols now, but when a salty medic says "Get outta the way, I'm going to intubate" even though we are so far from ROSC it's not even funny, I don't exactly have the ability to countermand that.

 

[StCEMT]

It's a systemic problem for me. We have CCR in protocols now, but when a salty medic says "Get outta the way, I'm going to intubate" even though we are so far from ROSC it's not even funny, I don't exactly have the ability to countermand that.

Yea, I can see that being a tough spot, which sucks. Assuming I know the EMT is familiar with what we are doing, I absolutely want a partner who will ask questions before I do something if they have a concern. I see no reason you shouldn't be able to, but I also get that some folks get pissy because "the EMT shouldn't be questioning me".

 

[DesertMedic66]

Try to get the tube with compressions in progress. If you aren't able to then just go with a King. Easy as that for me haha

 

[EpiEMS]

Yea, I can see that being a tough spot, which sucks. Assuming I know the EMT is familiar with what we are doing, I absolutely want a partner who will ask questions before I do something if they have a concern. I see no reason you shouldn't be able to, but I also get that some folks get pissy because "the EMT shouldn't be questioning me".

I appreciate it - it is irritating, but it shouldn't happen. I try not to "question the medic", especially on scene, unless it is something truly critical, but I'd like to have a better rapport with the ones who give me tsuris.

Try to get the tube with compressions in progress. If you aren't able to then just go with a King. Easy as that for me haha

Hey, if they were good they could Frankly, I think the evidence is at least as good for a SGA as an ETT, and probably (operationally) better when you consider hands off time for an ETT.

 

[bwat16]

nope

 

[MikeC]

I've seen it happen once, on an accidental OD on prescribed pain meds.... unfortunately, the patient happened to be a former linebacker and current LEO, so it was not fun during the first 30 seconds, but once he realized what happened, he was fine and grateful that we were there to keep him breathing and alive.

I have heard anecdotal stories about paramedics giving 2 mg of narcan and then leaving the room for BLS to carry the patient out, or giving 2 mg of Narcan as they are walking into the ER and letting the hospital staff deal with the projectile vomiting that follows. \

The majority of ODs who get Narcan don't wake up fighting, despite what many senior paramedics tell their newbies; I've dealt with more combative drunks than opiod ODs.
Probably similar to mine: good guys, good at the LEO stuff, not so great at the medical side, but if they can save a life with narcan before EMS gets there, they will. They are also the types who go into house fires with a fire extinguisher and try to put the fire out before the fire department gets there.

I do think the lack of oversight and accountability from a medical authority when it comes to LEO administered Narcan is one of the huge causes of this.

Our protocol states the goal of Naloxone use is mainly to restore one's respiratory drive, not to completely awaken them. It states ventilating/oxygenation of the patient takes priority over Narcan use. So ultimately, the goal is to get the individual to the hospital alive, breathing, but not completely awake, alert and oriented. I like how they take into account the safety of EMS responders with the tendency of opiod ods to get violent with administration of narcan. We have a pretty bad area with opiod overdoses.