Possible OD?

Cnowak07 · Jan 23, 2004

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.

tiredfeetED · Jan 23, 2004

In my County, prob one the last counties to have no Paramedics (Soon to change)..We have EMT I who can do very minimal (splints etc.) and EMT II. ALL calls are called in a orders are to be given for every pt by ambulance. On occasion if we are unable to get to the radio they can go on protocol such as ALOC protocol, which consist of IVL, chemstick, O's and narcan 2mg IV for suspected OD.

When hired as a RN you are expected to become MICN (Mobile intensive Care Nurse) approx after one year of ED experience. Bad part is Pay is not a single penny more, but now not only do I have pts but man the radio since we run lots of travelers. I got to admit though, I kinda like the prehospital care and respect those who do it for a living. We also do lots of transfers to Level 1 centers which require RNs to manage the Gtts, since there is such little scope of practice of our EMTs.

BarbPick · Jan 23, 2004

Originally posted by tiredfeetED
In my County, prob one the last counties to have no Paramedics (Soon to change)..We have EMT I who can do very minimal (splints etc.) and EMT II. ALL calls are called in a orders are to be given for every pt by ambulance. On occasion if we are unable to get to the radio they can go on protocol such as ALOC protocol, which consist of IVL, chemstick, O's and narcan 2mg IV for suspected OD.
When hired as a RN you are expected to become MICN (Mobile intensive Care Nurse) approx after one year of ED experience. Bad part is Pay is not a single penny more, but now not only do I have pts but man the radio since we run lots of travelers. I got to admit though, I kinda like the prehospital care and respect those who do it for a living. We also do lots of transfers to Level 1 centers which require RNs to manage the Gtts, since there is such little scope of practice of our EMTs.

Thank you for explaining and congrats for your new position, see even someone like me out of the ER loop (not units, just ER) and I even knew to give narcan.

MAGIK GIRL · Jan 23, 2004

what state do you work in and do your medics have standing protocols?

teeituptom, BSN, RN · Jan 23, 2004

Follow that Narcan with Revex when they get in also. That way you wont have to give narcan again when it wears off.

Keeps them in withdrawal for 6 hours, love it.

tiredfeetED · Jan 23, 2004

I work in Central California ( The forgotton part) and yes medics have protocols but must contact us (MICN) first. I think its lame, some of these guys have been doing this 15 yrs +, on the other hand others...well thank goodness they have to call in.

another funny thing is have u ever noticed that certain cases come in groups...today I had 2 ppl altered on methadone...one was skin popping with a nasty abcess who addressed me by OFFICER. The other was a guy with sats in the 70s who didnt like needles ( Go figure). He ended up biting the tube!

kc ccurn · Jan 23, 2004

Follow that Narcan with Revex when they get in also. That way you wont have to give narcan again when it wears off.

I've not heard of Revex before, what is it?

RNin92 · Jan 24, 2004

I gotta respond here!

I cannot figure out why anyone even questioned the Narcan at all!! Sounds like you were right on the money!

In Illinois we have ECRNs (Emergency Communication Registered Nurse). I don't know if that is anywhere else. But it is a separate license from the state- after a class and test and money, of course! You have to have your ECRN to be able to answer the squad radios and give orders.

Our EMS has protocols for EVERYTHING!! So our medics just run through them before they even call! Mostly, they are great! Of course we have a few who are more dangerous than the patient!!

By the way...with Methadone Man-with a GCS of 3 did your medics think about intubating? What about "...glascow less than 8=intubate" Makes waking him up with Narcan all the more fun!! No more buzz and a garden hose down your throat...makes you want to think before gettin' high again!!

:roll :roll :roll

caffine addict · Jan 24, 2004

Originally posted by Cnowak07
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.

I'm surprised as well. Most EMT's I've met would have tried that first.

teeituptom, BSN, RN · Jan 24, 2004

Revex is just a long acting narcotic antagonist, good for 4 to 8 hours. Even if they go out out and shoot right away it wont do them a bit of good.

Iam46yearsold · Dec 22, 2008

I like using Revex also