Trouble with Narcan

Nurses General Nursing

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Hello everyone! I am new to this site, and wanted to get feedback on narcan use from other people. Gave some ivp the other day for post surgery respiratory depression (RR

Well thank you all for your input, I know narcan has it's place but am still upset about it's use or maybe the EMS, I didn't like how they just shrugged when telling me it was standard procedure. This is my mother they're talking about they knew she had an enlarged heart and was on heart meds guess I am just venting thanks for letting me carry on. :-)

Specializes in ICU, telemetry, LTAC.
Just for clarification, your earlier post said she was prescribed 4mg Dilaudid q 6 hours, but a later post says twice per day. Just curious which it is ...

MLOS

She was allowed 4 mg of dilaudid every 4 to 6 hours. We only allow her 4 mg twice a day as she in lala land with any more. She seems to be able to cope with that. This has been prescribed and discussed with her primary, pain, lung and heart docs. As her primary care taker I have requested they never give it to her again. Her renal failure happened once in ER not in the ambulance. If they had done that to my husband who is on 149 mg of dilaudid twice a day for metastasized prostate cancer it would have killed him

I do not believe everyone is candidate for Narcan I have heard nothing but horror stories from the people who have had it including other nurses who had at one time or another been transfered by ambulance.

Holy moley that's a lot of dilaudid being used in your house.

Just for clarification, your earlier post said she was prescribed 4mg Dilaudid q 6 hours, but a later post says twice per day. Just curious which it is ...

MLOS

She was allowed 4 mg of dilaudid every 4 to 6 hours. We only allow her 4 mg twice a day as she in lala land with any more. She seems to be able to cope with that. This has been prescribed and discussed with her primary, pain, lung and heart docs. As her primary care taker I have requested they never give it to her again. Her renal failure happened once in ER not in the ambulance. If they had done that to my husband who is on 149 mg of dilaudid twice a day for metastasized prostate cancer it would have killed him

I do not believe everyone is candidate for Narcan I have heard nothing but horror stories from the people who have had it including other nurses who had at one time or another been transfered by ambulance.

How long of a time frame since leaving your house to the actual blood draws that led to the dx of renal failure??? Because I'm willing to bet that a BUN and Cr was drawn with the first lab tests.

I'm not a GU nurse, but I'm pretty sure she was already in ARF or was pre-renal before the ambulance arrived at your home. ARF happens fast, but not that fast.

Also, the references I use state that diladid is excreted by the kidneys. Which means the diladid most likely "built up" in her system. Nobody did anything wrong by administering the narcan, they did the prudent thing.

Specializes in Utilization Management.

I've had a couple of frequent flyers recently that would not rouse well for assessments. Both times I finally got so exasperated (because I could tell that both of them were awake, but they just didn't want to open their eyes and make a sensible response), I said, "Please wake up now, because if you don't I'll have to give you some Narcan."

OH MY GOODNESS! Suddenly I had very alert, oriented X3 and responsive patients.

Thank God, so far I've never had to Narcan any patient though!

Am I the only one bothered by the comment, "I didn't want that stupid junkie SOB enjoying it?" When will we begin to realize that addiction is a disease?? I am bothered by this attitude in our profession. I know how difficult and manipulative these patients can be, but believe we should be looking at them as people who are suffering not, as I've heard reference to them on the floor as, "the junkie in room 12", or "the professional drinker in room 11". Let's try to remember they are someone's Mother, Father, Brother, Sister, etc. Just my own 2 cents worth...

Thank you for this post. Even as a 15 year psych veteran, I am increasingly distressed by the "labels" we put on patients. "Addicts" can have pain too, and as you said, each "addict" is someone's family member. I firmly believe that labeling patients, even just to each other, can lead to subtle differences in how we interact with our patients, and can be perceived as judgemental. Sometimes there is little we can do for those patients that are stuck in their addiction except do our best to treat them with dignity.

Please don't misunderstand, I am not suggesting anyone is being disrespectful, but that our culture tends to be unforgiving with this population and it tends to come out in the words we use.

Specializes in Emergency Room.

I do take a little offense to "that stupid junke SOB" - I'm sure the RN was simply frustrated with the MD "caving" and giving the drug seeker MS. If you've ever worked ER, it is amazing how many people come in with seemingly legit pain that are just there for the pain meds. "The MD ordered some IM MS for your pain." Pt: "Oh, that will never work. It doesn't (insert excuse here)" Translation...."That sucks. IM MS won't give me that kick." Or, "Morphine doesn't work for me. The only thing that works is Demerol."

It gets very old very quickly, and my guess would be that this nurse has taken care of this patient before to the same end.

I'm not saying it is okay to label our patients, but we do it all the time - "The COPDer in room 12." "The MI in room 1." I understand the difference between a simple medical diagnosis as label and a judgment as label. It can be very difficult to keep the same level of compassion to a mean junkie who just wants a fix when you have a young man in the next room with DKA or TBI or something. Yes, addiction is a disease, but my patients need to want to help themselves before I can provide any treatment.

That is a terrible protocol, no offense to your institution or the RNs that work there. Have you seen this followed lately? I can only imagine the results.

I have to agree that this protocol is outrageous...who in their right mind wrote this? I also intend no offense to the RNs that work in this institution, but I guarantee the first patient who goes into pulmonary edema or even Vfib (yes, that can happen) after getting this dose of Narcan, it will not be good enough to just say "It was in the protocol."

I have to agree that this protocol is outrageous...who in their right mind wrote this? I also intend no offense to the RNs that work in this institution, but I guarantee the first patient who goes into pulmonary edema or even Vfib (yes, that can happen) after getting this dose of Narcan, it will not be good enough to just say "It was in the protocol."

Dosing in this manner will certainly yield you a nice onset seizure, hopefully not a hypoxic brain event, and I would bet an MI will happen shortly if this protocol is followed.

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