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Thread: Narcan (Naloxone) Training

  1. #81
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    Quote Originally Posted by 1168 View Post
    My agency is very generous with nasal capnography. The official stance is if I use it on everybody, we’ll just order more of them. I use it a lot.

    Capnography is one of the best tools available. It amazes me how little some people use it. What amazes me even more is how little hospitals use it.
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  2. #82
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    Quote Originally Posted by jwfuhrman View Post
    Capnography is one of the best tools available. It amazes me how little some people use it. What amazes me even more is how little hospitals use it.
    I’m surprised that it’s not in common use where you work. I can’t’ speak to pre-hospital management but in the hospital, it’s pretty much been the standard of care for all ventilated patients and all patients getting moderate or deep procedural sedation for the last 6-8 years.

  3. #83
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    ED’s in my area don’t use it at all, as far as I can tell. I’ve even seen pt’s intubated without it.
    RLTW

    “That is why there isn't an AK chart.” -SteyrAUG
    “They eat tide pods also so what's your point?” Retrorevolver77

  4. #84
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    Local EMS uses it, as do the local EDs with any ventilated patient or anyone getting procedural/moderate sedation. Some of the units using mod sed like vascular radiology do not use it, though.

  5. #85
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    Quote Originally Posted by Hmac View Post
    I’m surprised that it’s not in common use where you work. I can’t’ speak to pre-hospital management but in the hospital, it’s pretty much been the standard of care for all ventilated patients and all patients getting moderate or deep procedural sedation for the last 6-8 years.

    Yea up in NE Indiana it’s barely used. The service I work for uses it aggressively. If it’s anything other than straight BLS, they get Capno on. Such a fantastic tool! Hospitals take it off pretty much immediately.
    Owner of JF Arms Company


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  6. #86
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    The only good reason I can think of to carry narcan would be fentanyl exposure (to a responder)

    Funny thing, a few needle dispensers are giving dopers narcan so their battle buddy can bring them back from the light. Convenient.
    Last edited by J-Dub; 10-30-18 at 08:45.

  7. #87
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    Quote Originally Posted by J-Dub View Post
    The only good reason I can think of to carry narcan would be fentanyl exposure (to a responder)

    Funny thing, a few needle dispensers are giving dopers narcan so their battle buddy can bring them back from the light. Convenient.
    You can take advantage of this, in preparing your own first aid kit. Go get a free Narcan kit and keep it in your personal kit, in the event you need it off duty. My state has a standing order with the pharmacies to sell naloxone OTC without a prescription, but I learned that my insurance won't cover it unless it's prescribed to me. So I would be able to get it OTC, but I'd have to pay the full price, which where I live is about $140. I chose to use my state's opioid overdose program instead, and they were happy to issue me a kit with two 4mg Narcan nasal injectors, for free. You may be able to do similar, depending on where you live.

    Mass free Naloxone
    Last edited by p..; 11-29-19 at 17:07.

  8. #88
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    Quote Originally Posted by p.. View Post
    You can take advantage of this, in preparing your own first aid kit. Go get a free Narcan kit and keep it in your personal kit, in the event you need it off duty. My state has a standing order with the pharmacies to sell naloxone OTC without a prescription, but I learned that my insurance won't cover it unless it's prescribed to me. So I would be able to get it OTC, but I'd have to pay the full price, which where I live is about $140. I chose to use my state's opioid overdose program instead, and they were happy to issue me a kit with two 4mg Narcan nasal injectors, for free. You may be able to do similar, depending on where you live.

    Mass free Naloxone
    I can appreciate the idea of family or other bystanders being able to reverse an OD.

    However, those using it should not only be aware of the possibility of vomit but be prepared to keep the airway clear if/when it does happen. I've administered Narcan nasally, IV and even IO and while the nasal route is "gentler" in my experience, vomiting still occurs. If you let the victim vacuum up a stomach's worth of contents into the lungs, you've made things worse, not better.

    Violent wake-ups do happen and you may find yourself taking a fist to the face as a form of thanks. Be careful.

    The newer synthetics require far more than the usual dose and understand that even if they start waking up, your not going to shake hands and they go on their merry way. You still need to contact EMS.

    If you do find yourself in a situation where someone is ODing, what messed them up could mess you up. Fentanyl powder is something we've run into in my area and you could OD just as quick as the victim simply getting it on your skin. Be mindful of your surroundings if you get involved.

    Narcan isn't simply life saving water, either. It has been known to precipitate seizures in even small amounts in someone without opiates in their system. Again, have EMS on the way.

    Sorry for the diatribe but while it can be a good thing, knowledge and training are keys if the general public is going to have access to it.

  9. #89
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    FWIW, where I was able to pick up a kit the person handing it out ran me through a brief training. They aren't quite handed out blindly.

    I've only attended a couple of ODs with Narcan administered nasally, and coworkers have attended a couple more. Each time we ventilated for a few to several minutes before the Narcan was available, and then shortly after administration we got pretty agitated patients who wanted to start a wrestling match, but the ones I dealt with didn't vomit. Thanks for the heads up on the vomiting post Narcan, as I hadn't seen that before. At work I'm an EMT, not a Paramedic, and run as SAR/extraction, not on an ALS rig, so haven't administered or assisted administration via IV or IO. We carry nasal injectors in our kits. But we're not running OD call after OD call day after day.

    Our king tube protocol on inadequate breathing and unresponsive is if there is probability/evidence of opioid OD, to administer Narcan first and bag with a mask and reassess, so we don't do it the other way around inserting the airway first and ventilating then have someone perk up with a tube down their throat and then vomit for sure. As it happens, we usually bag for a few minutes with a mask and by the time the Narcan is handy we have enough people on hand that a wrestling match won't be an issue. We're not titrating just enough to get the breathing going again, we just administer the whole thing. The stuff we've dealt with so far, the patients have woken up after the first or second nasal dose, which is good because two is all we have in a kit.

    My personal off duty kit contains the things I need to help out for a few minutes while on-duty EMS is on the way. I have 2 CAT tourniquets, 2 6" OLAES bandages, trauma shears, CPR mask, a few pairs of nitrile gloves, a pair of leather gloves, eyepro, N95 mask, a foil blanket, and a Narcan kit. Very minimal gear for the first few minutes. In the places I normally am where I might run into someone who needs help, I am hardly ever more than about a 20 minutes response time away from someone who's getting paid do to this. The more I run various scenarios though my head though, the more I think I'll probably swap out the CPR mask for a BVM, and add some chest seals and a pack of Z fold combat gauze, and maybe a #28 NPA. I'm trying not to turn it into a full-on 5 minute bag though.
    Last edited by p..; 12-01-19 at 00:11.

  10. #90
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    “by the time the Narcan is handy we have enough people on hand that a wrestling match won't be an issue.”

    Is this group of people all going on the transport, or does a single paramedic have to ride in the back of the bus with a combative patient?

    “We're not titrating just enough to get the breathing going again, we just administer the whole thing.”

    This is one of the reasons I hate first responders giving Narcan.
    RLTW

    “That is why there isn't an AK chart.” -SteyrAUG
    “They eat tide pods also so what's your point?” Retrorevolver77

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