Friday, July 13, 2007

- Narcan, Noobs, and New Careers

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.

Even Mine!


Ambulance Driver said...

Well said, you stinky asshole. ;)

Chris in SE TX said...

Don't worry about those guys!

My wife is an EMT. She has worked with people that probably shouldn't be EMTs. She's worked with people that definitely should not be EMTs. I have heard her stories about those people. You don't fit that profile. I know that cops/firefighters/EMTs may laugh and joke at a scene of a fatal accident. It may seem inappropriate to many, but its their way of dealing with grief.

Your story about "No Bitey" was freaking hillarious!!! Period. The Narcan may have been questionable, but it was not done out of malice. It was not done as a joke. It was not done out of meanness.

At worst, I think it was a mistake. On top of that, it was done at the request / direction of your preceptor.

Your stories are great. Entertaining and funny. But they DO show compassion. I believe that is the most important quality in an EMT or Paramedic. Sure, you may save a life or two, but most of the time, the most important thing is for you to make the patient feel SAFE, COMFORTABLE and that they are in good hands. You seem to be doing that.

For you to be able to tell incredibly funny stories from those calls, that is just lucky for US!

I hope you will keep writing stories as you have. I have read all your archive stories and I have added you to the list of blogs I read. Please continue!

PJ Geraghty said...

Well, hell...I'm sure glad your preceptor didn't suggest defibrillation, otherwise (presumably) you might have lit the patient up. If you gave the med, even under a suggestion/order from your preceptor, that doesn't lessen your liability; it might help share it a little, but there will still be plenty of [feces] left to stick all over you.

My point? Humor is ok, and in some cases it can even be an appropriate part of patient care. There's a big difference between AD making a joke about rectal vs. oral thermometers with an otherwise healthy patient, and your mocking a psych patient to her face, and in front of others (including civilians). The former is funny; the latter is cruel.

Your explanation/apology goes a little ways towards improving things, but you have a long way to go to make it right.

Medicmarch. said...

PJ, I'd first like to thank you for coming at this with an even keel. I appreciate your comment and having a look at my blog. But I must ask you, when did I mock the patient to her face? I did tell her not to bite me.


Detail Medic said...

There is a fine line between making light and abusing a patient. Since none of us have been with you in any of these situations, it seems silly to make accusations about your treatment. Context is everything! But you know, the guy reading this who doesn't do the job - he's never going to get it. Blow it off.

Gary said...

You post a very weak defense. If you think your preceptor is wrong, you have to tell her that. It seems that SHE doesn't have a real clear picture of what Narcan is mean to be used for.

As to AD's blog, it's hilarious. If you think reading his stories is funny, you should sit on a porch in upstate New Hampshire with him and some other friends and hear him tell the stories. THAT'S hilarious.

Sense of humor? AD, another medic, and I are going to be doing a humor in EMS session at the Texas EMS Conference in November. I guess I some sense of humor.

Detail medic, as I said, I've been in EMS, full time, paid, urban system, since 1978. I've been a dispatcher, field EMT, communications supervisor, field supervisor, field medic, and just about every other non management position that my agency offers.

All of that being said, I stand by my remarks. Giving a drug that is not indicated is poor form.

Medicmarch. said...

Poor form that I've owned up to. Unfortunately my time machine is in the shop, so I'm not going to be able rush back in time to stop my past self from pushing the Narcan, because I think that's the only thing now that will make you guys happy.

Oh, wait a minute. I don't care. I admitted my mistake and discussed why it happened. As far as I'm concerned my part in this is done. I'm leaving the post up and everyone's comments on it up as well. You seem like an OK guy but I'm not going to force you to read my blog. I think if you looked past my glaring error you might find something that will amuse you. If not, don't let the door smack you on the ass on the way out. I'm sorry to sound like such an asshole but as I said this is my opinion on the matter.


Harry Balzac said...

It's not your humor, it's the fact you seem to think you're so damn funny. Most people who think hilarious ("Hey, look what I just said!") really aren't. I would rather read about your experiences (which are often compelling on their own) as a medic with some humor injected into it, rather than you pimping your self and how funny you think you are.