Our first Narcan

[Riblett]

Anyone who has been in this profession for any length of time as an ALS provider has had their first Narcan experience. We all laugh about the first time that we 'woke em' up' and the subsequent beating we probably received from the patient. In school the teacher will tell you to push it slow and only what you need. But it is not until you have that experience as the new gung-ho medic or intermediate that you vow to never make again.

Read mine, share yours, and special attention to new ALS personnel.

As a brand new EMT-I, I was called to a unconscious person at a nursing home. Arrive to find a 70-ish year old lady slumped over in her wheelchair, barely breathing and snoring with every breath. Has history of dementia and metastasized lung cancer and I suspected she had over done it with the pain pills. Having heard everyone sing the praises of Narcan and seeing Bringing Out the Dead one too many times the little orange box was practically screaming at me.

I slammed 2mg and she woke up-boy did she wake up. By the time we got to the truck she was swinging and trying to jump of the stretcher. Stupid of me to bring her out of her analgesia and back into the her world of pain and dementia that prevents her from communicating or understanding. The whole 45 minute ride the hospital I regretted that Narcan and was contemplating Versed with every punch I ducked. Now, I give enough to fix the breathing and no more.

[Eydawn]

Slightly off topic...

EMT-B's with IV approval can give IV, IM and IN narcan in the state of Colorado... is this worrying anyone besides me? Since we can't intubate... and we can't give stuff to counter seizures... and we don't have enough pharmacology (most of us) to understand how Narcan works and why... WHY did they give us this tool? :-/

Back to funny stories of Narcan admin...

Wendy

CO EMT-B

[JPINFV]

You know, that's one thing California has done right, EMT-B scope of practice and EMT-Intermediates. There are EMT-Intermediates in California (less than 200) and there is a wide range of options for expanded scope for basics (narcan included). Essentially an EMS system has to prove to the state that they can't provide paramedics to be able to use either intermediates or extended scope for basics. Paramedics available? Can't use expanded scopes.

[ccmedoc]

So how many have injected Narcan under the tongue? Right into the base of the tongue, just lateral to midline, right or left..

It is common practice around here, as well as other areas nearby. It is every bit as fast as IV, and if you can't get a line..... :wink:

As to the post...I honestly don't remember the first time I used it...

[emt322632]

ccmedoc,

Never heard of that. Here protocol is 2mg IV/IM. Only ever had to give it once, for suspected narc OD which turned out to be hepatic encephalitis.

I saw it pushed once when I was in ALS class, woman had actually ODd on her vicodin, woke her right up with the 2mg. She wasn't violent, but a little confused as to how she got in the back of an ambulance.

[p3medic]

I try to avoid the whole needle thing and go with the nasal atomizer.

[Mateo_1387]

My story is actually a bit different. I had a patient, a cancer patient, who was unresponsive. We determined that the patient had overdosed on their narcotic meds. The patient had vital signs within normal limits. I took the call and decided not to give any meds because I would have to make the man experience the pain from his cancer all of a sudden. We left it in the hands of the hospital because they would be able to give him other pain meds that would ease his pain without using narcotic receptors.

[akroeze]

Yeah, as far as I'm concerned there are very few situations where you would want to give Narcan.

[Medic26]

I try to avoid the whole needle thing and go with the nasal atomizer.

And as far as narcan, it should only be allowed in 0.4 mg doses that are carried in seperate amps. Where you get into trouble is pushing too much too fast from those 2 mg pre-fills.

[Just Plain Ruff]

You know if you push the narcan real slow I have found that even .1mg or .2 mg's work as well sometimes as the 2mg dosages that we tend to "slam"

Why do we still insist on using Slammed the med or what not. It just sounds so unprofessional.

Do you have any reason why this little old lady wanted to pull out your spleen thru your mouth after you slammed her with 2mgs of narcan??? I would suspect that she takes pain medications on a chronic basis and when you slammed that 2mg's all you did was reverse all the pain relieving effects that she had built up.

I had toradol slammed into my thigh one night for a tremendous headache after a butt load of narcotics had been administered to get rid of it. They even did a CT because they thought maybe I had a bleed since 100 mg's of demerol IM, 10 mgs over 20 mins of Morphine IV didn't touch it and 2mg's of dilaudid IV slightly touched it. I had the CT scan and it was normal and the nurse then gave me 30 mg's of Toradol IM in my right thigh(she slammed it) It was one of the most uncomfortable feelings I've ever had, it felt like she had just punched my thigh with a hammer. I felt that for 2 weeks. I spent 9 hours in the ER for the headache and thankfully I've never had a headache like that since.

Slammed medications are never the answer.