I will begin this post with a little anecdote. It was about ten years ago at Johns Hopkins Hospital and I responded to a "Code Blue" on the step-down unit. There was a woman, about 30 or 40 years old with several chronic medical problems who had stopped or nearly stopped breathing. I was at the head of the bed delivering bag-mask ventilation (bagging; using the Ambu-bag, the first responder kinda thing). We were preparing to intubate (insert a breathing tube into the trachea) the patient when an astute co-fellow, L.R., came on the scene and inquired as to whether the patient might be overdosed on narcotics. He said aloud "should we try some Narcan?" (Narcan counteracts the effects of narcotics and can cause arousal of a patient overdosed on them.) This patient who was comatose, not breathing, and unresponsive in spite of being bagged and poked and prodded by the numerous staff who responded to the emergency, suddenly awakened and exclaimed, vehemently and audibly through the bag-mask ventilation: "Nooooo! Not NARCAN!" Apparently, even a near-death experience is not as fearsome or worthy of arousal as reversal of the effects of narcotic medications.
Healthcare workers will find this amusing for its irony, and I could use it as a segue to a
soapbox soliloquy about the dangers of narcotics, but I've already blogged that rant. Here, I'm simply using it as a segue to a discussion about the use of Narcan drips in the treatment of overdosed patients. I was taught during a toxicology rotation in my residency a clinical saw that can be summed up as "
If there's an antidote, give it." Years of experience and reflection have borne out the wisdom of this adage. Narcan and other antidotes are often benign and as I have discussed in other posts, their benefits even in uncertain cases often outweigh their potential harms enough that they should be given.
Narcan is especially useful when available to heroin addicts, when used by first responders in the field, or when used as a "test" of whether depressed consciousness is due to the effects of narcotics (as part of the "
coma cocktail"). But when the decision has been made to admit a patient for observation after an overdose with prolonged effects, the question arises: should we start a Narcan drip?
