IO vs. IV in a drug overdose situation

[1EMT-P]

Recently responded to a 21yr old female who had overdosed on heroin. She was unresponsive but had a pulse when we arrived. In the back of the unit she became responsive to pain. Rather than start an IV for the Narcan/fluids, the medic dropped an IO in her tibia.

Just curious what the benefit to doing this was. Save time? Does the Narcan absorb more efficiently through the bone? I didnt see any track marks on her arms to indicate that those veins were no good but i didnt get too close of a look.

To be honest with you I am not sure as to why the medic placed an IO, as a rule of thumb most providers will look for an IV & make at least two attempts with in about 90 seconds before they consider an IO. Narcan can be administered several different routes so I am not sure why the IO was used.

[Medic7714]

I wouldn't have went straight to an IO on this patient. I would have at least attempted peripheral IV access. If no success then I would have went for intra-nasal. Heck, I may have went straight to intra-nasal. But being an OD with hemodynamic compromise I want IV access since we don't know for sure what else she took so I would have tried harder then a quick glance to obtain IV access. What if she took a combination of things and the opiate is maintaining a balance. Now take the opiate effect away and you could possibly have unopposed stimulants taking hold.

But yeah, just my opinion I think IO was a bit aggressive and overly invasive for this patient. BP was fine. Assist with ventilations / O2 and you will prob see an increase in heart rate as well. If that ALS service doesn't have an atomizer device they should look into getting one.

And I have to ask... why was the patients shirt and bra removed? I don't see the need for an OD to be fully stripped down to expose the chest. What was the Medic expecting to find on her breasts?

[2Rude4MyOwnGood]

And I have to ask... why was the patients shirt and bra removed? I don't see the need for an OD to be fully stripped down to expose the chest. What was the Medic expecting to find on her breasts?

Its been a while since i made this thread so much of the call isnt fresh in my mind, but i believe that her clothes were cut off to get the leads on as quickly as possible.

[Just Plain Ruff]

What was the Medic expecting to find on her breasts?

Ummmmmm Nipples?????

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[usalsfyre]

In an unconscious/unresponsive patient of unknown or yet undetermined etiology I'm going to strip them too, looking for trauma and signs of infectious process.

As for the I/O...uhhh,no. Luckily we have MAD devices here. I'm not 100% sure in the hemodynamically stable patient who's oxygenating themselves I would even give Narcan. Good chance it would be an NPA, 2L via NC and suction PRN.

[Medic7714]

In an unconscious/unresponsive patient of unknown or yet undetermined etiology I'm going to strip them too, looking for trauma and signs of infectious process.

I can understand that position. My only thing is when a high index of suspicion is pointing towards a drug OD, I don't see any need cutting a girls shirt and bra off. Remove the shirt okay if you really feel its necessary... but the bra and fully exposing the chest? Again, what is someone expecting to find on the breasts that is critical to figuring out what is wrong?

Just seems unnecessary to me. To us it seems quite trivial but to this girl it was her only bra. Just because a patient calls 911 doesn't mean we have the right to be inconsiderate of a persons property and clothing and expose them because we can. That's all I'm saying.

[usalsfyre]

I can understand that position. My only thing is when a high index of suspicion is pointing towards a drug OD, I don't see any need cutting a girls shirt and bra off. Remove the shirt okay if you really feel its necessary... but the bra and fully exposing the chest? Again, what is someone expecting to find on the breasts that is critical to figuring out what is wrong?

Just seems unnecessary to me. To us it seems quite trivial but to this girl it was her only bra. Just because a patient calls 911 doesn't mean we have the right to be inconsiderate of a persons property and clothing and expose them because we can. That's all I'm saying.

Understand what your saying, and I don't understand the reasoning behind cutting the bra either. The shirt, yeah. Bra? Probably overkill. How many people do you see that don't assess the patient though? I guess I'd rather see overkill and counseling than the alternative.

[hertzvanrental]

I definately wouldn't have gone IO first and would avoid EJVC unless in arrest situation. Do you guys administer narcan diluted or neat? If given IM then we give it neat but if given IV/IO then diluted in saline is best (shame there are lots of paramedics here who still blast it in neat ). Last thing you need is an addict waking up rapidly with an IO stuck in their shin.

[usalsfyre]

Why are you avoiding EJs outside of arrest? Certainly not my first choice but entirely appropriate for patients who REALLY need a line, conscious or not.

[hertzvanrental]

Why are you avoiding EJs outside of arrest? Certainly not my first choice but entirely appropriate for patients who REALLY need a line, conscious or not.

In an opiate addict OD??? Fair enough if you give narcan diluted and keep the patient semi conscious. But unfortunately there are staff (over here) who still give narcan IV undiluted, imagine the patient waking rapidly and pulling out their EJVC line. I know, these medics need re educating. These are usually the old school types though. Which reminds of a patient who was tubed, given narcan IV, woke rapidly and ran down the street with a ET tube tied in still. He sounded like a kettle whistling as he ran off!