The Combative Opiate Patient

firefite said:
All the medics I have worked with so far will only push enough to keep them stable but still not conscious. Then once we pull up to the hospital they will push a little more so the patient wakes up and can answer the hospitals questions. Better to have an aggressive patient at a hospital with countless people there then to have an aggressive patient in the back of the rig when it's just you and the patient.
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There is really no need to have an aggressive patient at all, anywhere. Just follow the easy two step program I outline above and they can happily wake up and go home.
 
Smash said:
There is really no need to have an aggressive patient at all, anywhere. Just follow the easy two step program I outline above and they can happily wake up and go home.
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To the most part yes. But we've had a couple of patients get aggressive because we "took their high away" and "made them waste money". No matter how you give narcan to that kind of patient, when they wake up their probably gonna be angry.
 
firefite said:
To the most part yes. But we've had a couple of patients get aggressive because we "took their high away" and "made them waste money". No matter how you give narcan to that kind of patient, when they wake up their probably gonna be angry.
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I always tell them if they want to fully enjoy their high, they need to warn the people around them not to call 911. They need to blame their sorrows on the people that call, not us.
 
abckidsmom said:
I always tell them if they want to fully enjoy their high, they need to warn the people around them not to call 911. They need to blame their sorrows on the people that call, not us.
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Ours somehow alway wonder off and we get called because they are laying on the side of the road. I've actually never responded to a OD with other people on scene. It's always just been the patient...... I wonder why lol
 
firefite said:
Ours somehow alway wonder off and we get called because they are laying on the side of the road. I've actually never responded to a OD with other people on scene. It's always just been the patient...... I wonder why lol
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Or just the patient with pants full of ice. It's like a giant "Some Idiot Was Here" sign. I love telling the people that ice thing is a total myth, but then I wonder how many people we *don't* see because the ice in the crotch woke 'em right up?
 
abckidsmom said:
Or just the patient with pants full of ice. It's like a giant "Some Idiot Was Here" sign. I love telling the people that ice thing is a total myth, but then I wonder how many people we *don't* see because the ice in the crotch woke 'em right up?
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I've heard of people doing that but sadly I haven't seen it yet. "be advised we are coming at you code 3 with an OD with blue balls" :rofl:
 
firefite said:
I've heard of people doing that but sadly I haven't seen it yet. "be advised we are coming at you code 3 with an OD with blue balls" :rofl:
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You know your response time has been long when their pants are just wet, lol.
 
Ice was old school, but worked sometimes.

Probably faking, sometimes.

Elavil OD violence, though,...real.
 
PoeticInjustice said:
It'll come in three stages. Stage 1 has about 25 new medications, some being:
Adenosine
Benadryl
Fentanyl
Versed
Dopamine
Levophed
Nitro drips
And many more, plus:
IV pumps
Video laryngoscopy (Ha!)
Bougies
NG tubes

Later phases aren't set in stone yet but will contain Etomidate, Ketamine, RSI, and ultrasound.

Don't laugh at us! :p We had a fairly archaic and very limiting medical director prior to our current one, so we're trying to catch up and jump ahead all at once (with appropriate steps for trai of course)
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Dang. I thought yall had most of that already.



Sent from my electronic overbearing life controller
 
Only pushed Narcan once, during my internship. It was via IO. The patient was extremely upset that we ruined her high and threatened to yank out the IO. After explaining to her how much pain this would cause her, she calmed down....slightly.
 
Great thread!
 
Chief Complaint said:
Only pushed Narcan once, during my internship. It was via IO. The patient was extremely upset that we ruined her high and threatened to yank out the IO. After explaining to her how much pain this would cause her, she calmed down....slightly.
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This reminds me of the time some overzealous medics in our county pushed Narcan down the ET tube!

Holy skill-happy medics, batman!
 
Chief Complaint said:
Only pushed Narcan once, during my internship. It was via IO. The patient was extremely upset that we ruined her high and threatened to yank out the IO. After explaining to her how much pain this would cause her, she calmed down....slightly.
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This is one more reason to add to the list of reasons I love the IN delivery route.
 
I've never had to fight my narcotic ODs... You wanna know why??? Cause I dont give them 2 mgs of Narcan at one time... Give em enough so they are breathing effectively...

You wanna know why they wake up puking and "shivering"? Cause you're probably sending them into withdraws...
 
Trevor said:
I've never had to fight my narcotic ODs... You wanna know why??? Cause I dont give them 2 mgs of Narcan at one time... Give em enough so they are breathing effectively...

You wanna know why they wake up puking and "shivering"? Cause you're probably sending them into withdraws...
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This is definitely the ideal way to do it...enough to breathe. But if they do wake up, going along with Chief Complaint's post, if they do wake up it's fun to see how ticked they are you took their high away. What would be even more fun is to tell them how cheap the Narcan is you used to take their high away, but that would just be mean.
 
Indeed, 2mg was too much for this girl. She came back immediately and had no apparent grogginess (is that a word?). She was also pretty pissed that we cut off her clothes as they were the only clothes that she owned. She was a street kid.
 
You know, I would be pretty annoyed too if you cut up my only set of clothes when I had no way of getting more and no way of keeping warm, and then whacked a nail into a bone in order to send me rapidly into withdrawal.

Why would you do all that? What purpose does it serve to treat her in such a fashion? It seems to me to be either extreme overkill or simply punitive Maybe that's why I've never had someone come up angry: I treat them like a human being, with a bit of compassion and dignity.
 
I have never seen narcan used. Our protocols are 1.6mg IM for adults and 20 mcg/ kg IM for paeds.

Our protocols tstae it should rarely have to be used and good oxygenation/ventilation should be sufficient.

Its only indicated for respiratory depression secondary to narcotics. An altered/ ALOC pt that is not resp depressed does not get it.

We only have small numbers of heroin users here, not as popular as it used to be.,
 
Smash said:
You know, I would be pretty annoyed too if you cut up my only set of clothes when I had no way of getting more and no way of keeping warm, and then whacked a nail into a bone in order to send me rapidly into withdrawal.

Why would you do all that? What purpose does it serve to treat her in such a fashion? It seems to me to be either extreme overkill or simply punitive Maybe that's why I've never had someone come up angry: I treat them like a human being, with a bit of compassion and dignity.
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I was just an intern on this call so it wasnt me calling the shots. I did as i was told.

When we found the patient she was unconscious with a weak pulse (cant remember rate since its been so long) and respirations at 4/min. She had very tight fitting jeans on and a tight long sleeve shirt that extended past her hands. Her clothes were cut off for 2 reasons, in an attempt to find a suitable vein for IV access, and to attach the leads for an EKG.

Again, i only did as i was told since i was just an intern on a ride along.
 
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