Should we use Narcan on all CPR calls?

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RobertAlfanoNJEMT

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I went on a call last week, 37 y/o male appeared healthy, CPR in progress died at the Hospital.. in hindsight I realize how it is strange for him to be in this situation at such a young age and could have been due to an overdose or bad mix of meds.. Should we give every CPR/non-breathing pt narcan? We don't know there history or how they got in that situation, and administering it cannot do any harm to them. Let me know what you think!
 
Narcan is not recommended in the treatment of cardiac arrests. Patients who overdosed will go into cardiac arrest due to respiratory arrest/depression. Giving Narcan isn't going to do anything for this patient because because the patient does not have a pulse. Since there is no pulse that means there is no respiratory drive.

If you have a respiratory arrest patient who still has a pulse then Narcan may be indicated based on assessment findings and scene surroundings.
 
I knew when I said "it can't hurt them to give it" that that would start some conversation.. I do not like to go by that logic often but in this case I kind of am for it
 
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
 
DesertMedic66 said:
Narcan is not recommended in the treatment of cardiac arrests. Patients who overdosed will go into cardiac arrest due to respiratory arrest/depression. Giving Narcan isn't going to do anything for this patient because because the patient does not have a pulse. Since there is no pulse that means there is no respiratory drive.

If you have a respiratory arrest patient who still has a pulse then Narcan may be indicated based on assessment findings and scene surroundings.
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What about in the situation where it isn't cardiac arrest but an irregular heart rythem such as sinus tach or v tach? That is what I believe had happened with my patient since the AED indicated a shock 5 times before I had cleared the scene
 
DesertMedic66 said:
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
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I was always told that there are essentially no side effects to Narcan other than those of opioid withdrawal.. can you tell me what these side effects are? I'm not here to challenge anyone's thoughts or knowledge, I am genuinely trying to get more information and insight on a topic I do not know all that much about
 
RobertAlfanoNJEMT said:
What about in the situation where it isn't cardiac arrest but an irregular heart rythem such as sinus tach or v tach? That is what I believe had happened with my patient since the AED indicated a shock 5 times before I had cleared the scene
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AEDs do not shock sinus tach. The only 2 rhythms that AEDs shock are V-tach (with no pulses that should be checked by the provider) and V-fib. Both V-Fib and pulseless V-tach are cardiac arrest rhythms
 
DesertMedic66 said:
AEDs do not shock sinus tach. The only 2 rhythms that AEDs shock are V-tach (with no pulses that should be checked by the provider) and V-fib. Both V-Fib and pulseless V-tach are cardiac arrest rhythms
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Thanks for that.. I think the issue with making equipment like the AED so user friendly is that it does not require the provider to learn the back ground info
 
RobertAlfanoNJEMT said:
Thanks for that.. I think the issue with making equipment like the AED so user friendly is that it does not require the provider to learn the back ground info
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If you're using an AED, you don’t need any background info. In the case of a cardiac arrest, you should apply the pads, push the analyze button and then hit the lightning bolt button if the box says "shock advised". If you need more background than that, become a paramedic.
 
RobertAlfanoNJEMT said:
Thanks for that.. I think the issue with making equipment like the AED so user friendly is that it does not require the provider to learn the back ground info
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AEDs are intended more for the public to use. Joe Q Citizen is working out at the guy and another friendly gym rat goes down. Mr. Citizen grabs the AED and puts in on and does exactly what the machine tells him to do. No real training is needed. As long as you can look at a picture and follow very basic steps you can use the AED.
 
RobertAlfanoNJEMT said:
I went on a call last week, 37 y/o male appeared healthy, CPR in progress died at the Hospital.. in hindsight I realize how it is strange for him to be in this situation at such a young age and could have been due to an overdose or bad mix of meds.. Should we give every CPR/non-breathing pt narcan? We don't know there history or how they got in that situation, and administering it cannot do any harm to them. Let me know what you think!
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If you're doing CPR, they need two (let's call it two and a half) things: compressions (and ventilation, eventually) and defibrillation. Naloxone, especially IM or IN, is probably not going to do very much - if anything. Firstly, it's going to distract you from more important things - compressions (and ventilations - which are what opioid overdose patients really need, if they need anything at all) and defibrillation. Secondly, it may not even circulate enough to do what it needs to do. Third, think about what naloxone does ("Naloxone is a potent opioid receptor antagonist in the brain, spinal cord, and gastrointestinal system") in the context of cardiac arrest. Not to mention, even if you get pulses back, there are downsides to naloxone administration in a peri-arrest state.

Short answer: Naloxone is indicated for severe respiratory distress related to or plausibly related to opioid overdose. It's not indicated for cardiac arrest.


RobertAlfanoNJEMT said:
I knew when I said "it can't hurt them to give it" that that would start some conversation.. I do not like to go by that logic often but in this case I kind of am for it
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It can hurt them - they don't need naloxone, they need compressions and defibrillation.
 
RobertAlfanoNJEMT said:
What about in the situation where it isn't cardiac arrest but an irregular heart rythem such as sinus tach or v tach? That is what I believe had happened with my patient since the AED indicated a shock 5 times before I had cleared the scene
Click to expand...

If your AED is recommending defibrillation for a patient in sinus tach it might need recalibration.

If your patient is in sinus tach because they have a decreased respiratory drive due to an opiate overdose, by all means administer narcan (carefully). If you believe that the v-tach (with a pulse) is caused by hypoxia related to an opiate overdose, fix the hypoxia then give the narcan when they're not in v-tach anymore.
 
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RobertAlfanoNJEMT said:
I was always told that there are essentially no side effects to Narcan other than those of opioid withdrawal.. can you tell me what these side effects are? I'm not here to challenge anyone's thoughts or knowledge, I am genuinely trying to get more information and insight on a topic I do not know all that much about
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Good for you man! Not everybody has the desire to learn (sadly), so it's good that you're asking questions.

Some side effects of narcan:
"Withdrawal reaction precipitated, abrupt reversal of narcotic depression may result in nausea, vomiting, sweating, tachycardia, increased blood pressure and tremulousness, cardiac arrest, ventricular fibrillation, dyspnea, pulmonary edema, abdominal cramps, diarrhea" (http://reference.medscape.com/drug/narcan-naloxone-evzio-343741#4)

Hope this helps!
 
medichopeful said:
Good for you man! Not everybody has the desire to learn (sadly), so it's good that you're asking questions.

Some side effects of narcan:
"Withdrawal reaction precipitated, abrupt reversal of narcotic depression may result in nausea, vomiting, sweating, tachycardia, increased blood pressure and tremulousness, cardiac arrest, ventricular fibrillation, dyspnea, pulmonary edema, abdominal cramps, diarrhea" (http://reference.medscape.com/drug/narcan-naloxone-evzio-343741#4)

Hope this helps!
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Aren't those all side effects of opioid withdrawal? I realize they are serious side effects but it's kind of the risk you take when you shoot heroin into your arm right?
 
DEmedic said:
If you're using an AED, you don’t need any background info. In the case of a cardiac arrest, you should apply the pads, push the analyze button and then hit the lightning bolt button if the box says "shock advised". If you need more background than that, become a paramedic.
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I have not LOL-d this hard in a while.

Op, if you're that interested in a paramedics drug kit, and what all they do and when to (or not to) use, as stated above...become a paramedic.
 
EpiEMS pretty much summed up what I was gonna say. Sure, you could think about it, but there is a nice list of other much more important things that need to be done first before even giving narcan.
 
RobertAlfanoNJEMT said:
Aren't those all side effects of opioid withdrawal? I realize they are serious side effects but it's kind of the risk you take when you shoot heroin into your arm right?
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Op, furthermore understand, I'm not laughing at you. You do seem genuinely curious. That is commendable.

Seriously, get your paramedic, chances are you'll do well. And yes, those are also common side effects for opiate-dependant withdrawals, but honestly you take too much of anything and it will make you sick enough to include the vast majority of the listed side effects.

Narcan is not a drug one should give anymore as they used to say 10-20 years ago when cardiac arrests were very much a "kitchen sink" approach. Prehospital medicine is ever changing, as is most, if not, all medicine.

The more prudent prehospital providers pride themselves on a strong clinically based approach, judging by your genuine curiousity, this makes for the solid foundation of a strong paramedic to be;).
 
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