CMP 066 – The Prehospitalist

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Into LIndsey “ The PreHosptialist”

Narcan – recap what narcan is

“Myth” of narcan-induced combativeness: anecdotal topic

How EMS providers are often the root cause of post-narcan agitation

Goal is to titrate narcan to adequate respirations, but in a world where everyone has 2-8mg narcan, EMS often arrives to a waking patient

Ways to not suck so bad:

1. Avoid swarming patients as they start to arouse
2. Avoid immediately asking “what did you take?”
3. Avoid offensiveness when patients deny drug use
4. Avoid prophylactic restraints in anticipation of combativeness
5. Avoid judgemental words, tone, nonverbals
6. Remember dogs, children and patients all have the following in common: they feed off our energy and mimic it

Other causes of agitation: hypoxia, hypercapnia

**ventilation/oxygenation prior to waking = happier awake patient**

Dosing extremes:

Some places: volume so high, not realistic to titrate and transport every OD

Other places: 0.04 mg IV titrated to respirations

Leaving patients after waking from Narcan: low-risk

“Numerous studies have evaluated the safety of patient refusal after naloxone resuscitation and have found extremely low mortality rates, ranging from 0-0.48% in the 24-28 hours after refusal [1-7]. In these studies, patients who passed the EMS system’s refusal criteria were allowed to decline transport to the hospital.”

Pulmonary edema super rare

Support:

Leaving narcan with patient

Addiction resources

Suboxone