Ok, this should be a fun one.

[EMTDenny]

Nah bro I was taking the piss, now get your white ass into that water and start swimming down from Kiribati or wherever the fuck you are, we can have a BBQ and get rotten drunk

I am going to start the EMT City treehouse club or something and have a big sign that says "NO EMERGENTOLOGISTS ALLOWED / COMPREHENSIVE DRINKING / KIWI ON DUTY 24 HOURS UNLESS UNCONSCIOUS"

That's a piss take on those signs you see in California which say "Emergency Department / Comprehensive Medical Care / Physician on Duty 24 hours" just in case you were wondering

Now that's a BBQ I would go too.

[Kiwiology]

Did we say you were invited?

Fine, you are invited but you have to bring a dish, and potato salad isn't a real dish, nor is anything pre-made from the deli section

Oh, and don't be bringing any of your damn New Yorker mates, especially not the snobbish kind nor those who tawk funny that you can't understand and none of those damn upstate volunteers who dont even carry a blood pressure cuff yo?

Actually, on second thought you can bring a dish and leave it on the picnic table and sit down the end of the street and watch out for that Emergentologist bloke, he's bound to try and crash our BBQ, if you see him text me and you might get a hot dog or something at the end of it

Also, bring beer

Edited February 24, 2012 by kiwimedic

[EMTDenny]

Did we say you were invited?

Any BBQ that aims for completely rotten drunkenness is pretty much an open invite.

Did we say you were invited?

Fine, you are invited but you have to bring a dish, and potato salad isn't a real dish, nor is anything pre-made from the deli section

Oh, and don't be bringing any of your damn New Yorker mates, especially not the snobbish kind nor those who tawk funny that you can't understand and none of those damn upstate volunteers who dont even carry a blood pressure cuff yo?

Actually, on second thought you can bring a dish and leave it on the picnic table and sit down the end of the street and watch out for that Emergentologist bloke, he's bound to try and crash our BBQ, if you see him text me and you might get a hot dog or something at the end of it

Also, bring beer

LOL you wrote that one quick. Funny ass hell. But just one hot dog.

[Kiwiology]

Now that I scrutinise this event more closely you can come and stay in the yard, but you have to still keep an eye out for the Emergentologist bloke

Your services will also be required after I've eaten so much I'm not able to stand up under my own power and need assistance

Hmm, it might also be required that you keep Dwayne in line, prick is liable to get rotten fucking drunk and start trying to be inappropriate or something, you can restrain him while I talk the cops out of taking him to jail and showing up with that van full of cops who show up to shut down parties, which means they basically club everybody over the head with a nightstick, if you put up a fight you get a dog set on you and your beer and food gets confiscated and goes toward the next Police Association fundraiser

[systemet]

What's the duration time of Narcan, average? I don't have my Epocrates window open... is it dependent on how much opiate is in the patient's system? (That's for you paramedic/MD type folks... I guess I could go look it up, but I'm really tired tonight!)

* Depends on what the patient's taken, and how much:

Selected opiods (t 1/2)

Narcan (60-90 minutes -- yes narcan is an opiod)

Codeine (150-180 mins)

Methadone (15 - 60 hours)

Morphine ( 120-180 mins)

Heroin (30 mins )

Oxycodone/percocet (3-4 hours)

Fentanyl (2.5 minutes)

Demerol / Pethidine (3-5 hours)

Propoxyphene/Darvon (6-12 hours)

Pentazocine (2-4 hours)

* Narcan competes for binding with the other opiates ingested. So, theoretically, if you had an IV pump with narcan on one arm, and an IV pump with morphine on the other, you could wake the patient up and put them back to sleep at will by adjusting the drip rates.

* There's going to be a certain plasma concentration of narcan that's going to treat the negative effect we're trying to prevent (e.g. apnea). The more opiate / opiod the patient's taken, the higher this level is going to be. How long the narcan lasts for will depend on how rapidly the narcan is being metabolised compared to the other opiate/opiod, and how much the patient's taken of the unknown drug.

* There's wide variability in individual patient's ability to metabolise different opiods, which may be due to tolerance from repeated exposure (e.g. in addiction), genetics, renal and hepatic function (lots of these people aren't healthy) and other non-opiod medications taken that are competing for metabolism.

* Other drugs will not only affect metabolism, but may have their own CNS affects. We've all probaby seen how unpredictable benzodiazepines can be when used with opiates for conscious sedation. If our patient has ingestion heroin+coke/meth, or has other depressants, e.g. alcohol, benzos, antidepressants, anticonvulsants, etc. then this may effect how long the effects of the narcan lasts.

Instead of ending up in this situation, life would have been better for all concerned if they'd just pushed 0.2 of narcan times, however much was necessary, until the patients breathing was adequate and their airway protected and then taken them to the hospital asleep, right?

I think so. This would be my preference, and would have been supported by physician oversight in the systems I've worked in. But this does seem to vary geographically.

[EMTDenny]

Now that I scrutinise this event more closely you can come and stay in the yard, but you have to still keep an eye out for the Emergentologist bloke

Your services will also be required after I've eaten so much I'm not able to stand up under my own power and need assistance

Hmm, it might also be required that you keep Dwayne in line, prick is liable to get rotten fucking drunk and start trying to be inappropriate or something, you can restrain him while I talk the cops out of taking him to jail and showing up with that van full of cops who show up to shut down parties, which means they basically club everybody over the head with a nightstick, if you put up a fight you get a dog set on you and your beer and food gets confiscated and goes toward the next Police Association fundraiser

Jesus, I wonder when the fun actually begins! That last part had me dying laughing LOL Police association fundraiser LOL

[Kiwiology]

Pentazocine (2-4 hours)

Wow last I heard of fortral was when we stopped carrying it here in 1990

[DwayneEMTP]

Kiwi, I'd jump all over that BBQ brother. It'd probably do you good to see how real men drink. I had a sitdown with some Aussies that were bragging yet had them flopping on the ground like fish trying to find their center of gravity before I'd even gotten a proper buzzz. And they claim that the Kiwi's are even more delicate still? Pitiful.

System, thanks for the above. That's awesome. I think that many forget, or don't realize that the relative effectiveness of narcan alone, and/or over time can't be completely understood in a vacuum, but must be compared to what it's antagonizing as well.

Allow it to compete with Heroine and it looks pretty good, Methodone, and not so much when the single dose 24 hr picture is considered.

Great post..

Dwayne

[ERDoc]

Denny, you will never get a protocol like the one you propose approved. It pretty much goes against everything America was built on (not to be too philosphical). You also don't need to be blasting every OD with narcan. It happens a lot in the field, especially in volley areas because they want to be able to do something cool. I only use it if the alternative is intubation. If they are sleepy but maintaining their airway, no need to give it.

I will be the first one at the BBQ and I will be prepared to f**k s**t up.

[triemal04]

In Australia the Metropolitan Ambulance Service (Melbourne) has been waking people up and leaving them at home for twenty years or more as they (at one point) had a huge heroin problem, anecdotally they say its quite safe

It was Austin I think that recently did an in house look at this; tracking how many patients were given narcan, refused transport, and then were found in the area's morgues. I believe the number was hovering right around 0.

I'd almost say that this is one of those things that has become part of EMS mythology; "if you give someone narcan you have to transport because it'll wear off and they'll stop breathing every single time!" Obviously there are instances where this may be true, but more often, in fact I'd say the vast majority of times it won't happen like that. It's going to be up to the provider to decide when the patient may need closer monitoring and might need another dose and when they are fine to move along on their own.

Of course that's the rub.