Four Loko

[HERBIE1]

I can't say why, beyond my pay grade, but all the medics I have worked with pushed the Narcan once they heard Four was on-board and it seemed (at least to me) to have the same effect. A few minutes after the push response came up, then the agitation, then the vomiting.

I never realized Narcan or its dirivatives were strickly opiode reversers. I have seen it used so much from drunks to crack ods I thought it was the cure all sober in 5 minute med.

Time to read up.

Probably simply SOP's. Most anyone with a depressed mental status for unknown reasons gets Narcan in our system. And yes, it IS strictly an opiate antagonist, but it's side effects are minimal and it could actually work.

Believe it or not, people actually lie to us when we ask if someone has been indulging in illicit drugs... LOL ///sarcasm off

[uglyEMT]

Believe it or not, people actually lie to us when we ask if someone has been indulging in illicit drugs... LOL ///sarcasm off

Patients lie thats news to me LOL

hope you saw the humor there

[Vorenus]

Probably simply SOP's. Most anyone with a depressed mental status for unknown reasons gets Narcan in our system. And yes, it IS strictly an opiate antagonist, but it's side effects are minimal and it could actually work.

Believe it or not, people actually lie to us when we ask if someone has been indulging in illicit drugs... LOL ///sarcasm off

Has to be due to your numbers of users. Around here, you wouldn`t just push an antidote without significant suspicion of the use of the drug.

Is flumazenil also in your SOPs for altered mental/conscious status?

[HERBIE1]

Has to be due to your numbers of users. Around here, you wouldn`t just push an antidote without significant suspicion of the use of the drug.

Is flumazenil also in your SOPs for altered mental/conscious status?

Yeah-in urban areas, folks will abuse damn near anything they can get their hands on- legal or illegal. Let's put it this way, in the ghettos, most providers carry a pocket full of Narcan vials and/or preloads because OD's are so common. A few years back we had an outbreak of heroin batches laced with Fentanyl. BAD. It would take gallons of Narcan just to get them breathing again. I wish we had Mazicon here- we've been asking for it for years, but our system is not exactly progressive, not to mention in large systems, any new drug or piece of equipment is a major expense, so they really need to justify it before we can carry it.

(edit to inset a forgotten thought)

Edited September 29, 2011 by HERBIE1

[BAYAMedic]

Flumazinil (ROMAZICON) although once in protocal, has lost favor in the ems setting. With its potential to cause intractable siezures when used appropriatly, the general consensous has been if they are on a benzo overdose, they can be more safely managed with an ET tube and vent time, letting their body process out the benzos on its own schedual and prevent the possible siezures.

[HERBIE1]

Update: Our patient was discharged home, but that's all I know. I need to speak with the folks who were working that day and I have not seen any of them since that day for updates on her condition and what they found with the toxicology screen, etc.

edit for spelling

Edited October 3, 2011 by HERBIE1

[Just Plain Ruff]

Flumazinil (ROMAZICON) although once in protocal, has lost favor in the ems setting. With its potential to cause intractable siezures when used appropriatly, the general consensous has been if they are on a benzo overdose, they can be more safely managed with an ET tube and vent time, letting their body process out the benzos on its own schedual and prevent the possible siezures.

As one who had the patient with the intractible seizures, needless to say it was horrible to realize that the do no harm mentality actually was doing harm to the patient.

One does of romazicon and the patient crashed into seizures we couldn't stop. Ended up paralyzing the patient but the brain seizures continued. Patient was flown to a level 1 trauma center/teaching facility but the damage had been done. This was 12 years ago and I don't know what happened to the patient after getting to the hospital but I did hear it was a permanent disability.

I spent hours filling out the incident report for the adverse drug reaction for that patient.

We set out to reverse the effect of the benzo but ended up hurting our patient. Not a fun thing to be a part of.

[zmedic]

The reason to use narcan is because the patient has depressed respiratory drive, not decreased mental status. The indication for narcan is respirations less than 12 a minute. The risk of narcan is taking a patient who is just chilling after an opiate OD and putting them into frank withdrawal. It may have some use in diagnosis but if you have to give it I think you should be giving dosages of 0.2-0.4 mg at a time. 2mg is too much unless you are about to intubate the patient.

I second no using flumazinil. Most benzo ODs aren't so bad that they can't control their airway. And the benzos may be keeping other withdrawal, like from alcohol, under control. Then when they seize giving more benzos doesn't work.

[Richard B the EMT]

After reading up about absinthe, this stuff is wild. There is even an entire society devoted to getting it legalized here.

There is also a large movement, which I am not a part of, for legalizing Marijuana for recreational purposes, not just medical.

As for proprietary recipes, even stuff that can only fatten you up can fall into that category, such as KFC's Col. Sanders' 11 herbs and spices, McDonald's "Secret" sauce, and the formulas for Coca-Cola and Pepsi-Cola (although a lot of the LEO "Procedurals" have had, during the run of the shows, a featured "Lab Tech" say they had one or more of these formulas figured out years ago).

[HERBIE1]

The reason to use narcan is because the patient has depressed respiratory drive, not decreased mental status. The indication for narcan is respirations less than 12 a minute. The risk of narcan is taking a patient who is just chilling after an opiate OD and putting them into frank withdrawal. It may have some use in diagnosis but if you have to give it I think you should be giving dosages of 0.2-0.4 mg at a time. 2mg is too much unless you are about to intubate the patient.

I second no using flumazinil. Most benzo ODs aren't so bad that they can't control their airway. And the benzos may be keeping other withdrawal, like from alcohol, under control. Then when they seize giving more benzos doesn't work.

Our Narcan doses per protocol here used to be 0.4mg here. Over the years, it was found this is not nearly enough and the starting dose has increased. The high potency narcotics we have on the streets makes 0.4mg completely ineffectual at even improving respiratory effort, much less level of consciousness. The vast majority of OD's we get are agonally breathing. I agree a smaller dose can be a good diagnostic tool, but to restore respirations, minimum doses here are around1.2mg- more if we know a load of bad(strong) dope is going around. We used to only stock vials of 0.4mg- not any more. Most hospitals now have 2mg vials or preloads as replacements for us.

A few years back we had a period where the drug dealers were cutting heroin with Fentanyl, and we could easily push 6-8 mg just to get the person's respiratory rate above 2. We actually had to get special deliveries where each apparatus would get a bag full of Naloxone to supplement our supplies. Often times these folks would even be put on Narcan drips once in the ER. NASTY stuff. We also had many OD's during that time where we were too late and could not revive the patients.

Since we do not have a benzo antagonist, it's use is not an issue with us anyway. Supportive care- that's it.