Should we use Narcan on all CPR calls?

[NPO]

If the cardiac arrest is due to opiate overdose, ventilation and oxygen is a much better fix than narcan.

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[EpiEMS]

RogueMedic, of blog fame, has a good post about this very issue.

 

[Carlos Danger]

If the cardiac arrest is due to opiate overdose, ventilation and oxygen is a much better fix than narcan.

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Not necessarily true. Opioids affect more than respiratory drive. A large overdose is effectively a chemical sympathectomy which ventilation will do nothing to treat.

 

[EpiEMS]

Not necessarily true. Opioids affect more than respiratory drive. A large overdose is effectively a chemical sympathectomy which ventilation will do nothing to treat.

At the BLS level, though, isn't the single most important (temporizing) intervention positive pressure ventilation?

 

[Carlos Danger]

At the BLS level, though, isn't the single most important (temporizing) intervention positive pressure ventilation?

Well if you don't have narcan available, then sure - you just do the best you can do. Which at the BLS level, means opening the airway and providing oxygen and PPV as needed.

But if the patient has arrested, then we've moved beyond the point where respiratory depression is the only problem we have to deal with. You still focus on the basics of CPR, of course - defib when indicated, chest compressions, ventilation. After that though, you start to think about reversible causes. That's where narcan comes in.

If the arrest is secondary to an opioid OD, then it's likely that the arrest was caused by hypoxemia, and you probably don't need narcan in order to resuscitate. However, if it was a very large OD, the sympatholytic effects of opioids could have played a role in the arrest, and could also play a role in making resuscitation more difficult. This is where narcan could potentially be beneficial.

Even if you aren't worried about the sympatholytic effects of the opioids, you still want the patient to breath on their own once you get pulses back, right? That's the simplest reason to use it.

 

[EpiEMS]

Even if you aren't worried about the sympatholytic effects of the opioids, you still want the patient to breath on their own once you get pulses back, right? That's the simplest reason to use it.

Absolutely - I just don't have great means of titrating to respiration but not full arousal, if you will, (and titrating is technically contrary to my protocols) with my IN naloxone.

 

[RobertAlfanoNJEMT]

Haven't been on in a while, but just read all of the messages. Good conversation, I think everyone learned something.

 

[NomadicMedic]

Haven't been on in a while, but just read all of the messages. Good conversation, I think everyone learned something.

Did you learn that narcan is in no way indicated for every cardiac arrest?

 

[RobertAlfanoNJEMT]

Did you learn that narcan is in no way indicated for every cardiac arrest?

No, I learned that administering it to a cardiac arrest patient with a suspected opioid overdose would be benificial.

 

[VentMonkey]

 

[StCEMT]

No, I learned that administering it to a cardiac arrest patient with a suspected opioid overdose would be benificial.

You....You realize you said the exact same thing worded differently?

 

[medicdan]

I'll quote a favorite medical director, "An overdose is not acute hypo-naloxemia, it is hypoventilation/hypoxia". Focus on treating the breathing. If no pulse is present follow the "C-A-Bs", focus on circulation.

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[VentMonkey]

Anyone ever get those Jems issues clumped together seemingly close, like before you've even gotten a chance to peruse the previous issue(s)? Anyhow, here's a not-so-bad piece applicable to the "Let's Narcan The World" folks.

http://www.jems.com/articles/print/...owing-naloxone-at-every-overdose-patient.html

 

[Ginger care]

What in this case makes you think it is reasonable?

Giving Narcan to a full arrest isn't going to suddenly bring them back to life. There is a huge difference between using Narcan when the patient has a pulse and when the patient doesn't.

Also, Narcan does have side effects

Yeah one of the biggest is now everyone and there idiot mother thinks we should sell it over the counter, giving drug dealers the brilliant idea to sell it with the drugs to idiot kids who think that now heroin isn't dangerous and end up overdosing anyway like you guessed it....idiots.

 

[NomadicMedic]

Yeah one of the biggest is now everyone and there idiot mother thinks we should sell it over the counter, giving drug dealers the brilliant idea to sell it with the drugs to idiot kids who think that now heroin isn't dangerous and end up overdosing anyway like you guessed it....idiots.

That is a shortsighted view. If your son or daughter had an addiction issue, wouldn't you think it would be prudent to have Narcan in the house? It absolutely should be available over the counter. And you certainly shouldn't judge opiate addicts simply because you don't like them or you don't like what they do.

 

[VentMonkey]

Could not agree with @NomadicMedic more. Ginger care, if this is how you view potential patients I feel bad for you.

Your post indicates lack of maturity, pointless judgment, and apathy. This in turn makes for the lethal triad on a quick road to burn out, if in fact, you're not already there.

 

[StCEMT]

Why shouldn't it be? It's more beneficial to have it for very obvious reasons. We are literally going to do the same damn thing once we get there and I know I personally like stuff done for me already. I might not agree with their career choice, but if drug dealers are selling it with their stuff then good for them. Hell, that's just smart business if anything.

 

[Ginger care]

That is a shortsighted view. If your son or daughter had an addiction issue, wouldn't you think it would be prudent to have Narcan in the house? It absolutely should be available over the counter. And you certainly shouldn't judge opiate addicts simply because you don't like them or you don't like what they do.

Never did I judge addicts so please don't twist my words to build your soapbox. Also I stand by my point that doing heroin is idiotic, not judging, dont think they are less human or scum of the earth. Im not going to withhold any level of care whatsoever, but how is it not idiotic....seriously if you think heroin is a good idea you are an idiot. Also I have kids, love them, but all kids are idiots at some point and if you have kids you know that. And last I checked heroin isn't really a "sorry I backed into the garage door" teachable moment, overdosing tends to be a little more permanent. Children are literally dying everyday from it and I don't see how telling them we can instantly fix them with a atomizer or injection is really the message we should send. If you paid attention I'm judging the DRUG DEALERS for taking advantage of something created to help people that is now being used as an aid to spread more poison by making it seem like it's without consequence. And it's not that I think you are stupid or naive, but I think its awfully shortsighted of YOU to think handing out this "miracle drug" like pez hasn't had equally negative impacts. But I get it, it's like pro life vs pro choice or thin crust vs deep dish everyone has there opinion and you sir or ma'am are certainly entitled to your's.

 

[Ginger care]

And for the record I really don't care what people are doing in there free time, do drugs don't do drugs it's your life. I'm saying not looking at it from both sides is a little reckless.

 

[Carlos Danger]

Never did I judge addicts so please don't twist my words to build your soapbox. Also I stand by my point that doing heroin is idiotic, not judging, dont think they are less human or scum of the earth. Im not going to withhold any level of care whatsoever, but how is it not idiotic....seriously if you think heroin is a good idea you are an idiot. Also I have kids, love them, but all kids are idiots at some point and if you have kids you know that. And last I checked heroin isn't really a "sorry I backed into the garage door" teachable moment, overdosing tends to be a little more permanent. Children are literally dying everyday from it and I don't see how telling them we can instantly fix them with a atomizer or injection is really the message we should send. If you paid attention I'm judging the DRUG DEALERS for taking advantage of something created to help people that is now being used as an aid to spread more poison by making it seem like it's without consequence. And it's not that I think you are stupid or naive, but I think its awfully shortsighted of YOU to think handing out this "miracle drug" like pez hasn't had equally negative impacts. But I get it, it's like pro life vs pro choice or thin crust vs deep dish everyone has there opinion and you sir or ma'am are certainly entitled to your's.

You have got to be kidding me.

Following your (lack of) logic, EMS shouldn't even respond to calls for drug overdoses. After all, what kind of message are we sending when we swoop in and attempt to save the life of someone who made such a foolish decision? We'll just encourage more heroin abuse.

While we are at it, let's stop responding to MVC's because let's face it, we probably encourage reckless driving by saving people from the consequences of their bad decisions.

Next we'll refuse treatment to lung cancer patients who have a history of smoking.