Speedylifsavr
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Just wanted to share a recent call I ran and get your opinions on narcan administration and what your protocols dictate .
Dispatched to cardiac arrest in a vehicle . I arrive on scene to find approximately 30 y/o female slumped over in her vehicle in a parking lot space with no visible damage . I sit her up and immediately notice she is very cyanotic , agonal respirations and cannot palpate a pulse , possible code . After a quick extrication , lay her supine on a backboard , do a quick jaw thrust and am able to detect a thready carotid . Start thinking OD , I control her airway O2/BVM/OPA and insert an 18g R EJ .
Pt has no visible track marks but an empty unlabeled prescription bottle was found in the vehicle . I suspect opioids or methadone....dont know why , just a gut . Blood glucose 170 . Our protocol for narcan is 2mg slow IV push . I administer .5 , then another .5.....and I see an very nice turnaround with my patient . RR increases 18 , skin dries up , she's nice and pink , spo2 100% and am able to place her on NRM and remove opa after some slight gagging .
At this point I start remeniscing about prior OD's and consider acute withdrawal syndrome . We are about 10min's out so I advise my partner to initiate transport . My rationale is If i adminminister the other 1 mg I am going to "awaken the beast" . I have run countless other OD's where I've given the narcan 2mg without a 2nd thought...but this one I had reservations , I deeply suspected acute withdrawal syndrome .
I called med control to relay my thoughts hoping they would understand my plea until I got the pt to a more controlled environment (ER) . I was rudely answered by a snappy nurse on the other end , who I just explained my suspicions to , who simply states "is there any reason you are not following your protocol?"...I then ask to speak to a DR...she comes back and says the DR wants you to treat per your protocol . She probably didnt even explain it to him .
Well....I administer the other 1mg....and the demon awoke.....thrashing , yelling , seizures , posturing , spitting and projectile vomit (her last meal was obviously chocolate doughnuts....gross)... I am in the back of the rig by myself , I control her airway best i can with suction . Luckily we arrive at the hospital and it takes a team of 7 doctors , nurses and techs to subdue her , medicate her and RSI her .
I really think with an understanding ear this all could have been avoided .I didnt get a chance to find out who the nurse on the radio was as we had to quickly clean up and get back in service .
What do you guys think? What do your protocols dictate?....ever experienced an nasty withdrawal?
Dispatched to cardiac arrest in a vehicle . I arrive on scene to find approximately 30 y/o female slumped over in her vehicle in a parking lot space with no visible damage . I sit her up and immediately notice she is very cyanotic , agonal respirations and cannot palpate a pulse , possible code . After a quick extrication , lay her supine on a backboard , do a quick jaw thrust and am able to detect a thready carotid . Start thinking OD , I control her airway O2/BVM/OPA and insert an 18g R EJ .
Pt has no visible track marks but an empty unlabeled prescription bottle was found in the vehicle . I suspect opioids or methadone....dont know why , just a gut . Blood glucose 170 . Our protocol for narcan is 2mg slow IV push . I administer .5 , then another .5.....and I see an very nice turnaround with my patient . RR increases 18 , skin dries up , she's nice and pink , spo2 100% and am able to place her on NRM and remove opa after some slight gagging .
At this point I start remeniscing about prior OD's and consider acute withdrawal syndrome . We are about 10min's out so I advise my partner to initiate transport . My rationale is If i adminminister the other 1 mg I am going to "awaken the beast" . I have run countless other OD's where I've given the narcan 2mg without a 2nd thought...but this one I had reservations , I deeply suspected acute withdrawal syndrome .
I called med control to relay my thoughts hoping they would understand my plea until I got the pt to a more controlled environment (ER) . I was rudely answered by a snappy nurse on the other end , who I just explained my suspicions to , who simply states "is there any reason you are not following your protocol?"...I then ask to speak to a DR...she comes back and says the DR wants you to treat per your protocol . She probably didnt even explain it to him .
Well....I administer the other 1mg....and the demon awoke.....thrashing , yelling , seizures , posturing , spitting and projectile vomit (her last meal was obviously chocolate doughnuts....gross)... I am in the back of the rig by myself , I control her airway best i can with suction . Luckily we arrive at the hospital and it takes a team of 7 doctors , nurses and techs to subdue her , medicate her and RSI her .
I really think with an understanding ear this all could have been avoided .I didnt get a chance to find out who the nurse on the radio was as we had to quickly clean up and get back in service .
What do you guys think? What do your protocols dictate?....ever experienced an nasty withdrawal?