So if you'll gander at the comments section of this Bleghmsjkdt! OR A Treatsie on Trustess of Modern Chemistry entry you'll see some pretty heated discussion (well, not actually discussion - more like me being ripped to shreds) on my administration of Narcan on the patient - a patient who was awake and breathing, when class and your common sense and protocols tell you that you only give enough Narcan to reinstate some one's respiratory drive.
Go check it out. I'll wait.
Waking them up with it is a big no-no, because A) Sudden withdrawal from a narcotic overdose is extremely stressful to the body - increasing the heart rate and blood pressure, possibly causing vomiting, and pain, and just generally upsetting and panicking the patient, and B) Do you really want to wake someone up so abruptly and painfully, then have them realize that it's your fault they're in this condition? Having someone go apeshit on you in the back of a 5x5x8 box is no picnic, cap'n.
These are things I know ("what? did why did you give it?" hold on-I'm getting there). I've only ever been taught to give it for known narcotic overdoses or unresponsives when we have no clue why the patient is down. So this leads us to the burning question voiced by Gary and JB, (and to make it clear, I'm paraphrasing- Good Ole Gar-Bear and Johnny B did not say this explicitly and they certainly were not vulgar) - MedicMarch, you shithead, why are you giving this person Narcan? From what you stated about the patient (hell, the fact you said that they were awake) and from what we've just read, this person had no indication for this medication to be administered to them. The fact that you gave it shows you have a complete misunderstanding of how the drug works and is malpractice. You disgust us, and you need to quit immediately before you hurt someone.
I know how the medication works, OK? It binds to the opiate receptor sites better then the opiate does and blocks their reception of the opiate, causing instant withdrawal...or something like that.
I'm gonna be honest here: I pushed the Narcan at the urging of my preceptor.
???Whiskey Tango Foxtrot???
Hey! Mom-Partner is his Preceptor! What is his preceptor doing telling him to give this patient Narcan? She doesn't need to be precepting if she's giving advice like that!
If I would've been running the call myself, I probably wouldn't have given the Narcan because I had no indication for it. Something I didn't add to the post was the discussion Mom Partner and I had as we were eating lunch, when I asked her: "Hey, why did we push Narcan?" and her answer "Because she was acting so strangely. Thought that might fix it," And then me going back to my cheeseburger. I didn't pursue the questioning any farther. Mom Partner didn't give me good enough reason to repeat the act of giving the Narcan in a similar situation, so I chose not to add that to the big bag of paramedic tricks in my head. I've precepted with three people so far and if I've learned anything it's that each person has their strengths and weakness, and I try to draw from the strengths of each to make myself a stronger medic.
Mom Partner may not have impressed you with her Narcan administration criteria, but let me also say this: The IV hints that Mom Partner gave me were invaluable and every time I stick an IV there's a little of her skill in me. I will agree that the patient, in all honesty, did not need or show the need for that Narcan I pushed, but I did push it, and my preceptor and I will be held responsible for that action should anything have come from it. I think that as both a preceptor and a preceptee you have to pay attention and be smart enough to filter and take out the good and leave the bad.
I posted the call for it's humor value, and I'm going to stand by the post. I think it's hilarious, and if you work in this profession you know that you need laughter to get you through some of the rough spots. I'm open minded enough to realize what makes me spit coffee all over my keyboard just laughing about it may not make you laugh, and make even make you curl your lip in disgust. If you don't find my brand of humor at all amusing, I don't blame you at all and furthermore respect your stance that I am a blubbering jackass.
That is, I will say that if you don't like what you're reading, I understand. My humor tends to be rawer and bawdy, like I am in person. Following the sage advice of someone I've come to respect immensely, I type like I talk. Professional? Not all the time. But this is ME, and this is MY BLOG. I'm not going to force it on you at all, so please change the channel if you're not into it - Ambulance Driver, for example, is HILARIOUS and posts frequently. I'm sure he's been doing this long enough so that you wouldn't find any fault with his humor, such as telling a patient he may've accidentally given them the rectal side of a thermometer orally. As I see from JB's blog page, you thought that was quite humorous, actually. I think it's funny too, but I if I didn't, and started to complain about how it disgusted me and that the possible transmission of Hep A was no laughing matter, and called for him to leave the profession, might you think I was being a bit over the top? This isn't a personal attack....just a little food for thought.
PS - Finding a new career? I'm not going anywhere. I love this job, and respect it, despite what you may have perceived as me not taking it seriously or as a lark. Get to know me before you make an accusation like that - work a shift with me, or hell, talk to me or my patients. I love what I do and I try to get better at it every day, and besides, judging and condemning someone for one post? Kind of lame. You guys have a valid point with Narcan issue, I think, but what I've take as some harmless fun in the comments section you've taken much too seriously. AD tells me you guys have a sense of humor, so hey....try and see it like that. And if you can't, I'm sorry...your loss, I suppose. Just remember, as my O-Line coach used to say, Opinions are like assholes, boys. Everyone's got 'em and they all stink.