Possible OD?

Uh NO....people are just stupid! :chuckle

Originally posted by tiredfeetED

Today I had this 30sumptin guy who was coming in by ambulance who was described as GCS 3 Pinpoint pupils, found outside by family who takes Methadone. Vitals were stale, Full C-Spine. Being a new MICN I ordered the basics fingerstick, High flow, IVL and Narcan IV ....the EMT II questioned my order of the narcan I had a doc close by who also agreed with my order. So I had to repeat myself..fastfoward pt. comes in now GCS 14, vomiting (while laying supine, the II threw a towel over the pt. face, and yes i wrote that up). Pt AMA bout 30 min. GCS 15 and pissed as hell..The RN who got him, who as many years my senior with ICU experience, stated that he couldnt believe that I ordered Narcan. I asked him what should of I do let him ride his high and see if he comes out of it? and he stated YES and was truly PO at me and the Doc. well bottom line was I in the wrong on ordering Narcan?:imbar

You were in the right. Yes and they wake up pissed off that you killed their buzz. You have to be really careful giving narcan or romazicon to hardcore drug abusers because you can throw them into withdrawl seizures.

Originally posted by Speculating

You were in the right. Yes and they wake up pissed off that you killed their buzz. You have to be really careful giving narcan or romazicon to hardcore drug abusers because you can throw them into withdrawl seizures.

Better than the alternative.............Drug users make poor organ donors.....

perhaps the medics were reluctant to give it as they don't like to clean vomit from the back of their bus?????

you had to order narcan in order to validate that this was indeed an overdose and not a neuro issue....i guess the other nurse felt that if the pt was breathing, why wake em and why make em vomit - but again many other more serious problems could have been masked as an apparent OD....

i am surprised you all let him sign out after a methadone OD - i will come back and kick him in the butt....

you are assuming he od'd on methadone....lol...I would've given the narcan, standard protocol, and our docs would've done the same thing. Also, our medics would've given the narcan as well. Just this week we had a 30something female found passed out, slurry words. Our new ED doc thought neuro, but we all thought something else (aren't we a suspicious bunch). Turned out her etoh level was 400!!! and she didn't even have the odor about her... She did stay in the hosp for that level.

i think you did the right thing. o2, finger stick, apap level, tca level, asa levels, lytes,cbc, drug screen, ntg, foley and narcan. the only thing i would have done differently (as long as vs were stable,) is do the narcan last. that way the ngt and foley are in and less mess to clean up. then if the pt wakes up and gets po'd he has a tougher time ama'ing and you have all the documented stuff done to cover your butt in the end.

because sure as shoot, one of his family members will find something to complain about. this way, you are covered!

Narcan was the right order, the doseage you didn't mention. After 24 years on "the bus" I can tell you I have standing orders that cover the OD presentation. "In them they state 2mg narcan IVP titrated to an sp02 of 95%." The reason they do this is two fold. 1.) Many pt's hate being awoken from their sweet high by Narcan. They often react violently or psychotically. You don't need to be wrestling with anyone in the back of moving ambulance if you don't have to, and don't need them trying to leap from your ambulance at 65mph on the interstate. (Poor prognosis due to poor concrete/patient interface). 2.) In todays era of body fluid precautions you don't need some addict vomiting all over you and ambo. Would you want be put on that cot, even if we did clean it.

Any experienced Paramedic would have given just enough to get the pt breathing well on his own, maybe wake him up a little. You stated you were giving orders to an EMT II. I'm not sure what level that is, maybe the same as NREMT-Intermediate? So perhaps they don"t have the luxury of tailoring orders to pt needs.

Just my experience, no slam intended. Good luck as MICN. Always look forward to speaking with a competent person on the base station when I call in.

Ok, I admit I am not up on my abbreviations, all that seeing dead people. Please tell me what a MICN is, I got the Glascow Coma scale.

BTW, I thought it was pretty much a standard order for people out of it to give narcan and D50 if low blood glucose, to cover all bases. That much could not have changed, or has it?

Narcan definitely was appropriate. In the rig always do a second survey before giving narcan. Had a guy pull a gun on the paramedic after his high was ruined with narcan....

Agree with giving Narcan. Just curious though, our medics run through their own protocols as far as interventions en route- we never give orders to medics- we get a brief report over the air and they let us know what they've already done. Do all the trucks call in to you to get orders?

GCS3 pinpoint pupils, known history..... Narcan was the absolute appropriate choice. Of course we always do the restraint drill before pushing the Narcan. LOLOL once you ride the right leg of someone coming out of a heroin OD, you wont forget the restraints.

Anyway, appropriate intervention, good job! Also, our medics would have already given the Narcan prehospital.

As a paramedic for the last 5 years I'm surprised your medics had to be told to give narcan. Not sure what an EMT II is so perhaps that was the problem.

Personally I would have given this pt just enough narcan to wake him up a bit and ensure a good airway. Sugar would have already been checked and perhaps offset with Thiamine and D50, if needed. IV and O2 are a given.

You absolutely did the right thing here. I'm surprised anyone questioned what you did. Perhaps you should be questioning why they weren't acting with the best interest of the patient in mind.