Trouble with Narcan

Yep....she was going through a withdrawal. I've given it to people who come in with heroin OD and that's happened. The "narcotic use hx" said it all.

Uh huh....

You see this ALL THE TIME in an ER. An OD comes in, you push narcan, they come back almost immediately and BOY are they pizzed off!

I just had to give narcan for the first time ever. Pt got a dose of dilaudid after already being on morphine 2 hours prior and her resp were 6/min. Jeeze she just kept getting lower and lower. Pushed narcan and in 2 min BAM back awake. She was all figity and anxious. She was more nervous everyone was around her kept calling for her husband but more scared. Then she calmed down. But wow that stuff works!

Uh huh....

You see this ALL THE TIME in an ER. An OD comes in, you push narcan, they come back almost immediately and BOY are they pizzed off!

One of my coworkers once Narcan'd a heroin OD. She came up fighting and cussing him out, demanding (cleaned up) "What did you do???"

Answer: "Your high go bye-bye!"

One of my coworkers once Narcan'd a heroin OD. She came up fighting and cussing him out, demanding (cleaned up) "What did you do???"

Answer: "Your high go bye-bye!"

:rotfl: :rotfl: :rotfl:

Yup! At an ER I was a tech at (MANY yrs ago), we had one of our frequent flyers come in with a nasty 8" long laceration to his thigh. Of course, he acted like he was dying; demanding pain meds.

The attending that night was new to our facility (and thus didn't "know" the pt.) and ordered MS (I think) IVP; the RN that gave it pushed it REALLY slow. Later, I asked her why she did it that way and her answer was "I didn't want that stupid junkie SOB enjoying it!":lol2:

Thank you so much! For awhile I thought I'd killed her! Apparently she told the doc/her family that she was "weaning off everything" when in reality she was not only taking her own med but her dead husband's meds too!!

clee, I had to laugh at your post. I've noticed I can tell the addicts by how they respond to ivp narcs - the addicts looove the rush, and everyone else is mad and wants the next dose slower!! lol

clee, I had to laugh at your post. I've noticed I can tell the addicts by how they respond to ivp narcs - the addicts looove the rush, and everyone else is mad and wants the next dose slower!! lol

Uh huh. I still chuckle about it everytime I see an obvious drug-seeker in an ER.

I've never had to have IV opioids, but I have had some large doses of hydrocodone PO post a root-canal gone bad; If the feeling of a normal opioid IVP is stranger than that, NO thank you!

never had a problem with narcan, at least yet. but I can see how this would happen. once gave a pt romazicon, and had he had a seizure. he had been taking ativan for an extended period and took an OD, was brought in by EMS, and ERP ordered romazicon. the results were awful. This was the only time I have had this happen.

We had an 80+ year old lady come in the the ER via EMS, once. Family thought she had a CVA, unresponsive, contracture-like extremities, pupils fixed. ERP suggested Narcan and almost immediately the LOL woke up and stated "you should have let me die"..., "when you are old, no one cares about you. They call to see if you need any food but you never see them". LOL was admitted and somehow she hoarded her meds and OD'd while in the hospital. Just goes to show, you have to make sure pts swallow their pills. LOL was sent to Greenleaf. I assume she is ok, haven't heard any different.

I work in an inner city ER - give Narcan almost daily. You do have to be very careful with it because it can kill - it precipitates seizures. Folks with sz disorder (something you may not know in your unconcious ER pt), usually sz and can go to status quickly. With heroin OD's, you need to ensure your pt is in four point restraints PRIOR to giving Narcan if at all possible. Narcan is not a cure-all either - you may have to give more than one dose in order to keep their LOC up.

Thanks for the tips r/t seizures! I'd left that tidbit buried deep in the recesses of my brain. Man, that would have sucked to push narcan for the first time as a nurse and have my pt sz unexpectedly!

Also, thanks for the 4-point restraint advice as well.

So does narcan always cause the delirium I saw? It seems when we've given it before, it just wakes folks up (and increases their pain...) but this was so violent... we were wondering if psych hx or anesthesia reaction played a part as well... and it turned out she did have a seizure disorder (found when family brought in all of the pill bottles, not in pmh)...

I guess I want to know what to expect next time (God forbid, but there will be one, I'm sure). I'm on a medsurg floor, so I don't usually get the od's until er is through with them; my pts who need narcan are usually othro postops, and they all have narc use/dependency for pain prior to coming in for surgery. This is the first one who went bats on me!