Narcan

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23 yo fe presents by ambulance to extremely rural level IV, in altered state, no ID. Bloods, BAL, cath UA obtained. PERRL, lacerations consistant with barefoot stroll in prarie (confirmed by SPatrol) evidence of old tape to B ACs, occipital lac well aproximated with staples appeared to be greater than 24 hours old. Repeating full name only, then begins to tell us the levels of angeldom needed to be bigwig angel. I was fortunate to 'out aura' (her story, not mine) her as mine vibrates much higher than hers; PFEEEW! She begins to trust me and follow simple commands. Head CT negative as well as BAL, ASA, Acet and Utox. MD du jour states other drugs will cause this level of psychosis and orders narcan. WOW did that **** the angel off! Fully cleared, now pre law student begins to threaten lawsuit. Short term question: What kinda drugs don't show on Utox (and result in completly NORMAL physical exam with PERRL and no slurring of speech? Car was clear for all paraphinalia, can you do shrooms and still have pupils that accomodate? What about payote? *not in season at the time of the incident, does it keep well?

Anywho, psych reports inital schizophrenic break, poor kid. Turned out she was an honor student at prestegious university, been missing for a week, parents didn't report it. Her boyfriend had just died and that was probably the catalyst for the break. Can anyone tell my why the narcan worked without evidence of drug? By they way I totally dig psych, must be my aura. TIA for answers! (MD was less than helpful with "I don't know why it worked but I was glad to get rid of her."

Cheers!

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Specializes in Trauma/ED.

If psych is reporting first schizo break it sounds like the Narcan didn't really work... There are some narcs that do not show up on a regular urine tox like Fentanyl, and Dilaudid...just depends on the test and how sensitive it is. When I worked surgical we used to have patients on Dilaudid PCA's come back with clean urine (suspected street drugs). Otherwise Narcan binds to the opioid receptors and would only help compete with something that involved these receptors...maybe it was just a timing thing...

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Specializes in ED, psych, burn ICU, hospice.

Psychotic break is reasonable: If I recall correctly, age is consistent with that, as well as the "angel talk" (religious ideations). Missing for a week might be consistent with poor nutrition (x 1 week) (guess you checked blood sugar?), exposure to the elements (not sure of location)...

"AEIOU TIPS" is a mnemonic to consider when dealing with AMS (altered mental status) (A = acidosis, E = electolytes, I = insulin... either too much/too little....).

Did the narcan really work, or was it a coincidence? As a previous post mentioned, the timing with some drugs can be "off," so screens may appear negative, when if fact, the pt is higher than Cootie Brown (Cootie is not a real person, but something to which we refer in my neck of the woods).

Also, consider "club" drugs. I think GHB, for example, is a special order lab.

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Specializes in ER, LTC, IHS.

Stll LOLing about "peyote not in season" Sorry I have no experience with this drug, just seems laughable that drugs have a season! ;)

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Specializes in Cardiac ICU, EMS, cath lab.

Peyote and mushrooms (psilocybin) cause the pupils to dilate. The same is true for LSD. GHB is a possibility, it won't show on most tox screens and is eliminated by the body pretty quickly. However, it sounds to me like its primarily a psych issue. Maybe the pt did have an opioid in her system as well that didn't show up on the screen.

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Stll LOLing about "peyote not in season" Sorry I have no experience with this drug, just seems laughable that drugs have a season! ;)

not being from the area, i may be mistaken, but i think it is used "straight" from the plant.....which is what the poster was getting at.....that the plant is not in "season" at this point in time.....

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Specializes in Cardiac Telemetry, ED.
not being from the area, i may be mistaken, but i think it is used "straight" from the plant.....which is what the poster was getting at.....that the plant is not in "season" at this point in time.....

Yes, Peyote is the plant (a cactus, to be specific), and the active ingredient is mescaline. There isn't really a "Peyote season", per se, but it is best to harvest Peyote after a dry spell, when the alkaloids are more potent. Peyote can be dried, and when dried, if properly stored, keeps just fine. The "buttons" can be consumed dried or fresh.

While possession of Peyote is prohibited by Federal Law, Native Americans are allowed to use it in religious ceremonies. Peyote has a long tradition of ceremonial use by Indigenous Americans, though people have been known to use Peyote recreationally (my parents and their contemporaries of the Baby Boomer Generation, for instance).

Mescaline acts by binding with serotonin 5HT3 receptors.

To me, this does sound more like a psychotic break, and the Narcan administration was probably coincidental. This would be just a guess, though.

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We had a rash of folks smoking Jimsen Weed... i don't know if that would have caused her symptoms, OR if it would respond to Narcan. The patients we had were very messed up from it though... not talking.

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I'd go with the new onset of Scizo disease. Classic case, most present during college years, hits high functioning kids in college. Bizarre behavior, multiple trips to the ER etc....

A little detective work may have helped--since she was recently stapled, and you're in a rural area, calling nearby ERs to see if she was seen elsewhere to try to get more history.

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