Last week in day two one of the pts was described as having an opiate overdose and coloneldom has asked whether I administered Naloxone (Narcan). Lets review firstly the job as I posted it.
'40F, OD on opiates, interesting because it's not her fault in my opinion. She has been prescribed by the one GP over ninety milligrams of a pain killer daily and therefore some days depending on her metabolism, other medication use and even stimulants like coffee she appears to OD.'
Naloxone Opioid Antagonist, reverses respiratory depression, sedation and hypotension caused by opioid analgesia.
Apart from the reversal of say Heroin ODs it can also be used to just back off on Opioid Pain relief with Pts.
My choice as a Qualified (the buck stops with you unless you call for Intensive Care Paramedics [Frogs - because everything they touch croaks]) Paramedic was not to give any Naloxone.
1. Pt was conscious.
2. Pt was fully ambulant.
3. Pt was not, while with us, in any life threatening danger.
4. Pt had refused transport and treatment initially which was her legal right as a pt who may have been under the influence of drugs but did display a competency and capacity to make decisions, even a bad one.
5. Pt only changed her mind after a short discussion with a staff member of the sanctuary she was was staying in. I did not hear any of the content but I believe it may have been coercion, but not by me.
6. I didn't wish to expose the Pt to possible infection from an IMI.
7. I didn't wish to expose myself to a possible needle-stick injury.
8. I wanted the Triage and ED Registrar to see with their own eyes the Pts true condition for assessment also of the GPs medication regimen.
Some of our allied Health Staff don't always believe what 'we saw' on the scene once a nicely package Pt is presented in the calm, controlled, well light, post any interventions by us, triage corridor.
So there you have it,
Simple short answer NO which doesn't explain the thought process to arrive at that answer.
It leaves me open to some prick thinking that I'm just a slack arsed ambo.
And doesn't provide direction to any Padawan reading the post.
I'm off back to bed for night shift tonight.
Be careful out there and I'll see you at the Big One.
Taz
31 August 2009
A Reply for Coloneldom.
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1 comment:
G'day Taz,
I'm a vollie in SA, just thought I'd chime in on the Naloxone issue.
I agree with your decision not to give it to a conscious, ambulatory patient. The only reason I'd like to give it is to restore respiratory drive long enough to get the punter to hospital.
At our level, we can only give 400mcg IMI. At paramedic level they have that option, as well as 100mcg increments (titrate to effect) IV and 120 mcg IN, The intranasal option is new.
I like the intranasal route because it's less likely to result in exposure to sharps and blood-borne pathogens, but the IV titration is (IMHO) more likely to give the optimum result (i.e. arrival at hospital with a patient breathing for themselves, but not aggro and trying to scarper).
Cheers,
Steve
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