What would you do?

[mobey]

Great Case.

Thanks Doc

[scubanurse]

Thanks... I'm going to ask my question though since I think it got lost.

Does osteoporosis have any effect on the decision to use an I/O or not? I know I/O isn't applicable in this case, but just curious.

[mobey]

Yes, osteoporosis is a contraindication to IO.

Contraindications are subjective though.....

[island emt]

Did we ever figure out if she had been double dosed at the facility ???

or was she just to the point of too much prescribed narc on board that started this whole episode of events?

Great way to teach and make us use our brains a little Doc

Edited October 15, 2013 by island emt

[chbare]

Well done Doc! Thank you for sharing.

[ERDoc]

It didn't appear that she was given any extra meds.

[HellsBells]

Wow, is there actually instances where medics slam 2mg of narcan at the hospital door because they think its funny? I honestly would not regard anyone who would perform in such a manner professional, or competent in any sense of the word.

[rock_shoes]

Wow. This case blows my mind. It's one of the most glaring examples I've ever read of a drug most paramedics view as being "relatively benign" spiralling patient care out of control. Titrated low dose naloxone=self managed airway with short afternoon hospital stay (most likely). High dose naloxone=extreme pain/agitation/withdrawl, intubation, central line, chest tube, and an ICU stay.

Out of my own curiosity, what is the typical naloxone dosage protocol for most people here on EMTCity?

I work under a guideline system so I've used anywhere from 0.4-2.0 mg IM or IV depending on the patient and the desired effect. Usually I give just enough for the patient to maintain their airway and self ventilate. In the case presented the initial dose would probably have been 0.4mg IM. The only time I've ever pushed naloxone 2.0 mg IV is in a code where opiate overdose was a suspected cause (repeated as needed in the code situation).

[scubanurse]

I've usually seen it drawn up 2.0mg and given very very slowly 0.4mg at a time or lower to respiratory effect. My current facility does not allow RN's to use narcan without a MD order (no standing order for it) though which I think is a bummer considering how much we use opiates.

[Just Plain Ruff]

0.4 mg to 2.0 mg depending on situation

And if I never ever want orders from a specific ER again, I'll slam 2.0mg of narcan down a heroin overdose's IV right as I open the door of my ambulance and wheel them into the ER. (YES I'm joking) but the never getting orders again applies on this. But I'd never slam the narcan - that's just bad medicine and it makes you an ASSHOLE Of the highest degree.