Opioid overdosing?

The code nurse was rude and shouldn’t have behaved that way. It is best to cultivate an environment where nurses feel safe calling rapids and codes. If not, inevitably there will be times when no one calls a rapid because they fear being “that nurse that called a stupid rapid for no reason” and will wait to call until the patient has severely deteriorated. 

I think you did a good job. The only thing I would say is that if you have patients on opioids, there should be PRN Narcan and I would have retrieved and used it if this patient was somnolent and bradypneic, you can save a person from intubation. Sounds like you did great, though, you got a physician and others to the bedside for evaluation. You took care of your patient. 

As a side note, I’d check into the policy for belongings for patients like this. In my ICU we go through everything to make sure they don’t have any contraband or substances they can take under the radar. I know it’s tough with visitors bringing things in though. 

Sounds like that nurse overreacted, not you. For an opioid overdose I would definitely expect to see bradypnea, but I would expect pinpoint pupils, not dilated. With all other vital signs WNL it's hard to say. But you had a concern, you addressed it appropriately and the patient is fine. If that nurse is going to be responding to rapids and codes she should be supporting and educating nurses, not berating anyone for doing what they think is in the best interests of their patients. 

I agree with normalsarah, it's so important to go through patient belongings for medications. I once had a patient in ICU, maxed on levophed and in septic shock. His wife gave him his night time meds when I had walked out of the room, included coreg and lopressor!! My intensivist was NOT happy, to say the least. And we recently had a very sick young lady in ICU, she was an overdose patient. We got her extubated and up to the floor and her significant other brought pills in for her. She overdosed again and later died. So sad. 

I worked in a methadone clinic for 7 years, and  yes she was definitely over dosing. Good call. The one thing I wanted to tell you is that after you give a dose of narcan you need to continue to monitor their respiratory rate hours later due to methadone's long half life. At one ER a old patient of ours when in for methadone over dose. He received the narcan and then was sent home. He later died of the methadone because he needed to be monitored for further administration of narcan. Methadone is a scary drug to give. I left that job because of it.

On 4/3/2021 at 1:09 AM, darren_callcareer18 said:

“she is breathing it is just very shallow!” 

Shallow breathing does not guarantee good oxygenation. You were as Florence Nightingale said "keeping careful watch over the sick".  What an ineffectual support team member, I hope she has some better qualities. I may have missed it but what was her pulse ox?