Unconscious kid lying in a room

[NYMedic828]

Why are you jumping to narcan?

Naloxone is a drug. It has indications. We don't just push it blindly "just in case".

Agreed 110%.

First off, empty beer cans is a good indicator of alcohol being the cause.

Secondly, unless I need to rule out opiates for an unknown AMS, I only give narcan for respiratory depression.

Alcohol does not cause respiratory depression. If my patient isn't breathing or is not going to be much longer, then it's narcan time. Otherwise, let them stay asleep and be happy and not make my time with them miserable.

Also, speaking of aspiration which someone stated, if you have a very intox patient who is mixed with opioids and you narcan then you are only increasing your risk of withdrawal and inducing the vomiting you are trying to prevent...

OP don't listen to us, none of us know what we are talking about :rolleyes

Especially veneficus. That guy doesn't know jack!

 

[heatherabel3]

I didn't mean to imply that what we did was 100% right. I'm sure we did get things wrong, it was our first ever scenario. I am still a student myself. What i was trying to say, was that if his question is because he has a practical he's getting ready for, he should be prepared to not follow the assessment verbatim. We never got a history or had time for a secondary assessment. Also not to get side tracked with the small stuff out of the gate and look for tge life threats. I was trying to help, not be an ***.

 

[Aidey]

But it is also important to remember not to blow things out of proportion to the point that you over treat and aren't able to actually assess the pt because you are so busy bagging a patient who doesn't need it. In this scenario it is important not to get so hung up on c spine you never get around to actually checking for respirations, or a pulse, or a blood sugar.

 

[Veneficus]

I certainly would not have BB, unless it looked like there was obvious trauma where they jumped from a significant height I would call Al's so they could push narcan or I would transport depending on where they are and ED is.

Narcan for a drunk?

How does that work?

 

[NomadicMedic]

Narcan for a drunk?

How does that work?

Not very well, I'm told.



Another example of how the level of education for EMTs is totally inadequate.

 

[Veneficus]

Alcohol does not cause respiratory depression.

As an FYI, alcohol, benzos, and barbiturates all inhibit GABA receptors. (each a different one)

In the CNS, the limbic system really wants to be inhibited. (it has a lot of these receptors)

while that has to do with inhibition (especially reproduction) and not breathing, from the theorhetical standpoint, if benzos and barbs can inhibit respiritory effort, so can alcohol.

On the practical side, the pt may die of acute liver failure first, but I am just pointing out the problem with absolute statements.

Especially veneficus. That guy doesn't know jack!

Who is jack?

 

[Achilles]

Narcan for a drunk?

How does that work?

How do you know he didn't take drugs?

 

[Achilles]

Not very well, I'm told.



Another example of how the level of education for EMTs is totally inadequate.

Sorry I didn't respond right away I had other things going on today which didn't involve monitoring this thread.

 

[Achilles]

Let's stick an epi pen in his neck. Maybe there was a bee in one of those bottles of Natty Ice he was downing.

If you say so.

 

[Aidey]

How do you know he didn't take drugs?

Why assume he did even if the assessment doesn't support it?

 

[Veneficus]

How do you know he didn't take drugs?

How do you know he doesn't have a genetic mitochondrial disorder that inhibits him from aerobic metabolism and doesn't need a dose of bicarb to reverse his acute acidosis?


If it looks like a duck, quacks like a duck, and walks like a duck, it is a duck until proven otherwise.

When you hear hoofbeats, think horses.

If he is breathing, then he doesn't need the narcan anyway.

If he did take drugs, how do you know it was an opioid?

What if it was a benzo, a barbiturate, THC, an amphetamine? A chemical like whiteout or paint? (can you believe they still make that stuff?, who uses it?)

What if it was a large dose opioid and you have to set up a narcan drip?

But here is the rub.

The more what if's you know, the less practical it becomes to look for them.

Start with the basics, air in and out, blood round and round.

 

[rwik123]

How do you know he didn't take drugs?

Go lookup something called the Opioid Triad.

Usually by the environment and surrounding of the patient you can make a pretty good assumption on weither or not your dealing with an opioid overdose.

I have Narcan in my toolkit...should I start pushing it on every drunk that passes out on my campus?

So much facepalm.

 

[Handsome Robb]

How do you know he didn't take drugs?

You don't. That's why we do thorough assessments. I'm not trying to hate on basics and I am a brand new medic but this is exactly why I don't believe BLS providers should have naloxone in their scope.

Like Vene said, if it looks like a duck and quacks like a duck, it's probably a duck.

There are indicators that I look for when giving naloxone. The key ones being evidence of use (empty bottles or other) pinpoint pupils and respiratory depression.

Even if someone is unconscious after ingesting opiods but still has a good respiratory effort, isn't cyanotic and has a good Sp02 I'm not going to give them naloxone. I don't want to deal with them being grumpy and withdrawing in the back of my ambulance. Like someone else said, titrate to a respiratory effort, not to wake the patient.

No one is jumping on your case but trialing naloxone in every unresponsive patient is terrible medicine.

 

[NYMedic828]

How do you know he didn't take drugs?

Assessment based management

Let's look at the factors of your assessment.

-Scene - beer bottles all over. Are they open/empty?
-bystanders - what does the roommate know? History of drug abuse?
-patient - incontinent, face down. No signs of injury.
- odds are he didn't get hurt, or not bad enough for me to think c-spine injury. The human body is meant to fall from standing height and not be injured at that age. C-spine is not a concern to me.
-history - drug abuse? Seizures?
-assessment - glucose, 3 lead, BP, HR, RR. The basics.

You need to consider everything before determining your treatment. Sure maybe he did take opiates. So what. Odds are he is not suffering from a neurological condition be it injury or illness and as long as his breathing ok, I don't care what he took if I can't immediately determine it.

I only need to give narcan if his breathing is hindered. Otherwise, quite honestly while I do care if he took other drugs, I really don't.

 

[bigbaldguy]

Folks if someone says something that is incorrect feel free to correct them but let's do it in a friendly, professional way. There are those who have lot's of info and experience and those who have little. The one's who have little will stop listening if you slap them down for giving the wrong answer. Eventually they stop trying to answer and then they stop trying to learn. I am disappointed with the tone of some of the posts in this thread.

 

[Tigger]

I'm a bit tired of hearing how basics shouldn't have naloxone in their scope because they don't know enough about it. Most basics that answer a scenario with "they should get narcan" don't have the ability give it. All their "education" on it is second and third hand. And then there are those of us that do have it, and received actual education in its use. If someone actually gets formally educated in its use, they would more than likely have a better grasp on its use. It's a bit absurd to say that a medication or skill shouldn't be given to basics because they don't know how it works. Well duh, no one has educated them on it! You don't give a medic a new med or skill and tell them figure it out either...

 

[Aidey]

It isn't just about the narcan. As many many threads here illustrate and through real life experience, it as been shown that when all you have is a hammer, everything looks like a nail. Everyone gets oxygen. Everyone gets backboards. You get the picture. Until there is a fundamental change in EMT education and how they are taught to approach the differential diagnosis I have a hard time supporting expanding their scope to include more medications.

 

[abckidsmom]

(Hoping that you knew this was a joke...lol)

This condition refers to a state of limbo where you cant cross the finish line due to CNS depression, presumably due to an imbalance between prolactin and dopamine.

So you're not at "zero", and youre not at "ten." More like a steady "five".

And the award goes to Doczilla for the most amusing family friendly explanation of a sensitive topic.

I've got nothing to add here other than this.

 

[Tigger]

It isn't just about the narcan. As many many threads here illustrate and through real life experience, it as been shown that when all you have is a hammer, everything looks like a nail. Everyone gets oxygen. Everyone gets backboards. You get the picture. Until there is a fundamental change in EMT education and how they are taught to approach the differential diagnosis I have a hard time supporting expanding their scope to include more medications.

Point taken. I guess it just sucks to be lumped into a group of people that are capable of nothing more than the minimum. The obvious solution is to increase my education, which is unfortunately just not in the cards right now.

 

[Akulahawk]

Start with the basics, air in and out, blood round and round.

Any deviation from that is bad... And if you find something wrong with the air going in and out and/or the blood going round and round, fix it or get the patient to someone that can.

The basics aren't all that hard... the minutae is what'll drive ya batty!