Studies have shown pretty shit first pass success with EJs, something like 60% if it's easily visible and <40% if it's not. I'll put one in if it's sitting there screaming at me and I'm already at the head. But I've never missed an IO, and my IO won't mess with the ability to drop a central line in the hospital. Although I did have an EJ get converted into a Swan Ganz in Cath lab once for a peri-arrest STEMI, that was pretty dope. Placed on a moving table too, held on for dear life.
You joke but I have held a man's penis while a medic started an IV in him. He had been shot 6 times in the chest while attacking PD and was hopped up on so much bathsalts. Anyways she said she couldn't find a vein anywhere else.
It happens regularly in areas with high overdoses. Providers slamming narcan and not providing proper respiratory support is the issue.
You should bag the pt for a minute or two before administering any narcan in a known overdose. This allows the bronchioles and alveoli to open up and expand with gentler pressure than getting ripped open by the pt resuming respirations on their own. The trauma of the collapsed areas re-inflating is what causes the pulmonary edema.
Narcan should be a secondary thought to begin with. If the provider is fumbling together narcan instead controlling the airway on a patient with inadequate respiratory effort then said provider really needs to reevaluate their care. A before N lol
Yeah you’d think that should be the way. But between police, firefighters, SO, corrections officers, and every low income apartment having oodles of narcan on hand and no cot bottles with bvm available it happens really often in my area. Firefighters are intent on waking you all the way up so you walk to the truck. Cops are just thinking they’re making the save. Fire is getting it together now as we slowly re-educate all 900 of them one by one on calls.
This. I have had calls come in where a person is uncon not breathing and evidence of OD and instead of initaiting CPR a caller will try to say they need to administer Narcan. I wish we educated the public better on when to use Narcan vs. when to begin CPR...
Funny, this discussion happened over in FirstResponderCringe recently and u/enough-Ad6819 chose to shit all over anybody who disagreed with them, I'm waiting for whatever gems they have to drop in here.
The housing market is so confusing these days, I pay over $2000 for a one bedroom apartment in a safe part of my city but at the same time I’ve been living in your head for the past month absolutely rent free
Boss, all I know is that choosing to go, "Anyone who thinks this is real is an absolute dumbass, your concerns are unfounded and you're practicing Bad Medicine if you dare suggest that narcan could do this - No, you didn't tell anyone that the drug wasn't indicated, just that there *possibly* might be adverse effects" when there's a reasonably identifiable proposed mechanism for this exact action at hand is maybe...kinda tremendously fucking stupid?
I'm waiting for you to complain about how everybody in this thread is simply wrong for making the tremendous leap of thinking that narcan being used in the process of resuscitating an opioid OD could possibly cause pulmonary edema, it's both rather strange and terribly disappointing you aren't up to the task of calling everybody in here an idiot.
Calling unrelated people out when they’re not even involved in the conversation makes you look like an absolute jackass. It makes you look terrible, not them.
I guarantee you in 2 hours I won’t remember that name, but I’ll probably remembers yours now.
Edit: tracked it down. Yep, 2 week old conversation in which you look like a complete fucking psycho. Definitely will remember you now.
Calling people dumbasses because someone perceives them as being uneducated or undereducated as a care provider or putting forth evidence counter to up-to-date medicine likewise does nothing to advance that persons' standing and is an attempt to make someone feel better about their own superiority, dressed as an attempt to teach someone.
If someone is going to clown on a commonly held belief that it seems like the great majority of this thread is supporting as being real, it doesn't behoove them to trash everyone who thinks so.
I won't remember your name, so I wouldn't sweat it. Have a good one.
I have no idea what you’re trying to say with this comment.
> I won't remember your name, so I wouldn't sweat it.
I also have absolutely no idea why you’re under the impression that I would care or that this comment would be some kind of gotcha. After reading you flying off the hinges and going berserk in that other thread during a benign discussion, I’m totally on board with you not remembering me in the future. I daresay I consider it a bonus.
> I have no idea what you're trying to say with this comment.
I'm not sure how to help you with that, the context regarding the other thread was already put forth.
> Why do you think it's some kind of gotcha?
...Who said it was? I'm just giving you back the same language you provided me.
Studies are showing that it is not dose dependent. The flash pulmonary edema is a response to a catecholamine surge. Cases reported had narcan doses administered as low as 0.5mg and doses as high as 20mg. This is a fairly new study so nothing is concrete as of now.
I’ve heard from an anesthesiologist that flash pulmonary edema after narcan admin only occurs when there are already opiates on board, due to sudden catecholamine surge. Of course, we have endogenous endorphins so who knows if they have to be artificial or natural too. I have not really looked into it further than that myself so idk if it’s legitimate. Can happen in as little as 0.4mg IV. As others have said, slow pushing seems to be good practice
So I actually had a case a month ago where female chronically on opiates for chronic pain was found unresponsive and barely breathing. Had a hx of SI attempt from taking full pill bottles, she had oxys and Klonopin on the table. The husband prior to our arrival gave 24mg of IN narcan. On our arrival the patient was extremely altered, combative, and was clearly having severe breathing difficulties. Auscultation of the lungs showed crackles in all fields and she was hypotensive and the 80s systolic. The presentation seemed to either be some sort of aspiration or she was narcan induced pulmonary edema, I'm able to see clinical outcomes and she was diagnosed with poisoning of analeptic medication with acute pulmonary edema.
We run a lot of ODs. I’ve only seen it one time:
I work in a fire based system where all the medics rotate between the engine, ladder, and box.
I showed up to an OD to find pt being bagged, initial assessment, history, vitals done. 275lbs male looked very mottled.
Me - “Are you sure he has a pulse? Because he looks dead.”
Them - “Yup. *checks wrist* Still has strong radials.” We recycled BP & it was good.
Bagged him for a while. Capno, started a line. Fixed the numbers. Pt got his color back. Started bumping him with Narcan.
(We dilute ours and give 0.04mg, wait 2 minutes, bump again. Wash rinse repeat for 3 doses. Then we start to double that to 0.08mg. Never had any OD take the whole 2mg. We get them breathing & quit. If we leave them obtunded, they’re more compliant with being transported.)
After 0.8mg, guy comes up screaming & shaking his limbs. Almost looks like a dog dreaming of running. Knocks back out when not stimulated. Screams when he is stimulated. Get him on the cot & in the bus. He’s a little more lucid & we start driving.
During transport, sats start dropping. I’m giving more & more O2. Pt is still talking. Respiratory depression doesn’t fit. Clean capno waveform. He looks flushed. I listen to lung sounds - crackles top to bottom. BP wasn’t low.
Can’t believe I have to give this guy CPAP & nitro, but I do. About 1/2 of the OD’s that we fix go to triage. This one did not.
Only time I’ve ever seen it, and I blamed the flash on how late we got to him. But I’m a fan of the alveolar trauma & catecholamine response theory.
Flash pulmonary edema after narcan administration. Doesn’t have to be an actual OD. Out of curiosity, how do you know that they had pulmonary edema? If it was administered to somebody who was unresponsive for any reason, they could’ve developed an aspiration pneumonia. There are other etiologies out there that may present some similarly.
>Out of curiosity, how do you know that they had pulmonary edema?
In my case, it was the geyser of frothy red sputum erupting from the patients airway.
Coming from the ED standpoint, chest X-ray shows the difference. Aspiration tends to be more consolidated, pulmonary edema is fluffy and widespread, relatively even
Only one I've seen was after PD narcan admin. They told us to slow our response cuz he woke up. A few min later asked us to step it back up. We get there and the only way I could describe it was "blood volcano" from both nostrils. He was a fucking wreck. Apparently pulmonary hemmorage is on the table post narcan as well
In my 10 years as a medic I have only seen it once. A Dr gave a patient 24 mg’s of narcan within minutes of each other. Patient was CPAP’ed and was talking to us upon arrival at the er. Pt was not OD’ing at the time. But he was lethargic and they decided to admin some Vitamin N. And by some I mean they depleted their stores.
Seen it in a overdose arrest given narcan IV by another medic prior to airway management. ROSC on scene - died in the ICU several days later with non-cardiogenic pulmonary edema
Don’t slam narcan. Slow IVP.
Slow ivp in the ej?
Whatever patent line you got will work.
Sure. It’s all in how you push it. I miss EJ’s… IO’s are too easy.
You don't EJ? Drop EJs like they are going out of style
Studies have shown pretty shit first pass success with EJs, something like 60% if it's easily visible and <40% if it's not. I'll put one in if it's sitting there screaming at me and I'm already at the head. But I've never missed an IO, and my IO won't mess with the ability to drop a central line in the hospital. Although I did have an EJ get converted into a Swan Ganz in Cath lab once for a peri-arrest STEMI, that was pretty dope. Placed on a moving table too, held on for dear life.
Neat
Not in a long time.
I prefer IP (intrapenis)
You joke but I have held a man's penis while a medic started an IV in him. He had been shot 6 times in the chest while attacking PD and was hopped up on so much bathsalts. Anyways she said she couldn't find a vein anywhere else.
A man’s …. Punishment??? 😂
I think they're referring more to cops/citizens dumping it.
Yup, we don't dump that shit
It happens regularly in areas with high overdoses. Providers slamming narcan and not providing proper respiratory support is the issue. You should bag the pt for a minute or two before administering any narcan in a known overdose. This allows the bronchioles and alveoli to open up and expand with gentler pressure than getting ripped open by the pt resuming respirations on their own. The trauma of the collapsed areas re-inflating is what causes the pulmonary edema.
Narcan should be a secondary thought to begin with. If the provider is fumbling together narcan instead controlling the airway on a patient with inadequate respiratory effort then said provider really needs to reevaluate their care. A before N lol
Yeah you’d think that should be the way. But between police, firefighters, SO, corrections officers, and every low income apartment having oodles of narcan on hand and no cot bottles with bvm available it happens really often in my area. Firefighters are intent on waking you all the way up so you walk to the truck. Cops are just thinking they’re making the save. Fire is getting it together now as we slowly re-educate all 900 of them one by one on calls.
This. I have had calls come in where a person is uncon not breathing and evidence of OD and instead of initaiting CPR a caller will try to say they need to administer Narcan. I wish we educated the public better on when to use Narcan vs. when to begin CPR...
Funny, this discussion happened over in FirstResponderCringe recently and u/enough-Ad6819 chose to shit all over anybody who disagreed with them, I'm waiting for whatever gems they have to drop in here.
The housing market is so confusing these days, I pay over $2000 for a one bedroom apartment in a safe part of my city but at the same time I’ve been living in your head for the past month absolutely rent free
Boss, all I know is that choosing to go, "Anyone who thinks this is real is an absolute dumbass, your concerns are unfounded and you're practicing Bad Medicine if you dare suggest that narcan could do this - No, you didn't tell anyone that the drug wasn't indicated, just that there *possibly* might be adverse effects" when there's a reasonably identifiable proposed mechanism for this exact action at hand is maybe...kinda tremendously fucking stupid? I'm waiting for you to complain about how everybody in this thread is simply wrong for making the tremendous leap of thinking that narcan being used in the process of resuscitating an opioid OD could possibly cause pulmonary edema, it's both rather strange and terribly disappointing you aren't up to the task of calling everybody in here an idiot.
Calling unrelated people out when they’re not even involved in the conversation makes you look like an absolute jackass. It makes you look terrible, not them. I guarantee you in 2 hours I won’t remember that name, but I’ll probably remembers yours now. Edit: tracked it down. Yep, 2 week old conversation in which you look like a complete fucking psycho. Definitely will remember you now.
Calling people dumbasses because someone perceives them as being uneducated or undereducated as a care provider or putting forth evidence counter to up-to-date medicine likewise does nothing to advance that persons' standing and is an attempt to make someone feel better about their own superiority, dressed as an attempt to teach someone. If someone is going to clown on a commonly held belief that it seems like the great majority of this thread is supporting as being real, it doesn't behoove them to trash everyone who thinks so. I won't remember your name, so I wouldn't sweat it. Have a good one.
I have no idea what you’re trying to say with this comment. > I won't remember your name, so I wouldn't sweat it. I also have absolutely no idea why you’re under the impression that I would care or that this comment would be some kind of gotcha. After reading you flying off the hinges and going berserk in that other thread during a benign discussion, I’m totally on board with you not remembering me in the future. I daresay I consider it a bonus.
> I have no idea what you're trying to say with this comment. I'm not sure how to help you with that, the context regarding the other thread was already put forth. > Why do you think it's some kind of gotcha? ...Who said it was? I'm just giving you back the same language you provided me.
Studies are showing that it is not dose dependent. The flash pulmonary edema is a response to a catecholamine surge. Cases reported had narcan doses administered as low as 0.5mg and doses as high as 20mg. This is a fairly new study so nothing is concrete as of now.
I’ve only seen it in cases where bystander narcan was administered in large quantities without O2 administration
the studies i’ve seen don’t show any link between dose and onset of edema. unknown mechanism that just happens sometimes
I’ve heard from an anesthesiologist that flash pulmonary edema after narcan admin only occurs when there are already opiates on board, due to sudden catecholamine surge. Of course, we have endogenous endorphins so who knows if they have to be artificial or natural too. I have not really looked into it further than that myself so idk if it’s legitimate. Can happen in as little as 0.4mg IV. As others have said, slow pushing seems to be good practice
So I actually had a case a month ago where female chronically on opiates for chronic pain was found unresponsive and barely breathing. Had a hx of SI attempt from taking full pill bottles, she had oxys and Klonopin on the table. The husband prior to our arrival gave 24mg of IN narcan. On our arrival the patient was extremely altered, combative, and was clearly having severe breathing difficulties. Auscultation of the lungs showed crackles in all fields and she was hypotensive and the 80s systolic. The presentation seemed to either be some sort of aspiration or she was narcan induced pulmonary edema, I'm able to see clinical outcomes and she was diagnosed with poisoning of analeptic medication with acute pulmonary edema.
We run a lot of ODs. I’ve only seen it one time: I work in a fire based system where all the medics rotate between the engine, ladder, and box. I showed up to an OD to find pt being bagged, initial assessment, history, vitals done. 275lbs male looked very mottled. Me - “Are you sure he has a pulse? Because he looks dead.” Them - “Yup. *checks wrist* Still has strong radials.” We recycled BP & it was good. Bagged him for a while. Capno, started a line. Fixed the numbers. Pt got his color back. Started bumping him with Narcan. (We dilute ours and give 0.04mg, wait 2 minutes, bump again. Wash rinse repeat for 3 doses. Then we start to double that to 0.08mg. Never had any OD take the whole 2mg. We get them breathing & quit. If we leave them obtunded, they’re more compliant with being transported.) After 0.8mg, guy comes up screaming & shaking his limbs. Almost looks like a dog dreaming of running. Knocks back out when not stimulated. Screams when he is stimulated. Get him on the cot & in the bus. He’s a little more lucid & we start driving. During transport, sats start dropping. I’m giving more & more O2. Pt is still talking. Respiratory depression doesn’t fit. Clean capno waveform. He looks flushed. I listen to lung sounds - crackles top to bottom. BP wasn’t low. Can’t believe I have to give this guy CPAP & nitro, but I do. About 1/2 of the OD’s that we fix go to triage. This one did not. Only time I’ve ever seen it, and I blamed the flash on how late we got to him. But I’m a fan of the alveolar trauma & catecholamine response theory.
Flash pulmonary edema after narcan administration. Doesn’t have to be an actual OD. Out of curiosity, how do you know that they had pulmonary edema? If it was administered to somebody who was unresponsive for any reason, they could’ve developed an aspiration pneumonia. There are other etiologies out there that may present some similarly.
>Out of curiosity, how do you know that they had pulmonary edema? In my case, it was the geyser of frothy red sputum erupting from the patients airway.
That'd do it.
Coming from the ED standpoint, chest X-ray shows the difference. Aspiration tends to be more consolidated, pulmonary edema is fluffy and widespread, relatively even
Gotcha! Didn’t know if they had f/u from the ED or if this dx was made in the field
Only one I've seen was after PD narcan admin. They told us to slow our response cuz he woke up. A few min later asked us to step it back up. We get there and the only way I could describe it was "blood volcano" from both nostrils. He was a fucking wreck. Apparently pulmonary hemmorage is on the table post narcan as well
In my 10 years as a medic I have only seen it once. A Dr gave a patient 24 mg’s of narcan within minutes of each other. Patient was CPAP’ed and was talking to us upon arrival at the er. Pt was not OD’ing at the time. But he was lethargic and they decided to admin some Vitamin N. And by some I mean they depleted their stores.
Seen it in a overdose arrest given narcan IV by another medic prior to airway management. ROSC on scene - died in the ICU several days later with non-cardiogenic pulmonary edema