tol is Tolerance.
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Tolerance is part of the equation, but breathing and circulation play a huge role too
If a nasal spray is administered but the person isn’t breathing it will still be absorbed, but if oxygen levels are low af it’s going to take more time, therefore you keep pumping the narcan until you’re sure. When I’m standing over an OD’ing street kid, I’m taking NO chances.
Same thing with intramuscular injections. Yes the drug is in the body but circulation helps a lot and if the heart has slowed or stopped… well. You keep pumping shots of narcan until they die or come back.
Final most important is that the user or person attending may believe the user took fent, but they probably had a dangerous street concoction consisting of fent + any other number of who-knows-what. Often referred to as “down”. There’s absolutely no way to know if they need more narcan because of tolerance or something else
edit: At the end of it all, there is no way after the fact to determine what the “correct” amount of narcan was for that situation. It is highly situational and depends on many factors. The rule is if you’re not sure, more narcan, because this ain’t the time to guess wrong.
That’s pretty much exactly what I was told back when narcan first started being available easily for pain patients and such. There’s too many factors involved to piss around with trying to calculate anything in the time you have available to make it work, so you just give more and pump that damn chest.
There is no maximum dose of Narcan and more won’t harm a person. The general guideline is every 2-3 minutes until revival or death.
Chest compressions can kill an overdosing person if their heart is still beating, so not always chest compressions. This is the scariest decision to me…
I’ve worked in crisis shelters so I have wayyyyyyy more exposure to OD’ing people than anybody ever should :(
Damn. I’ve only been around a few, what with home health patients making maybe mistakes and playing gopher in the local ER. It was actually worse, for me, than stuff like strokes or heart attacks. There’s just this extra edge of “wtf” to it.
Luck of the draw, the first day I was in the ER, still 17 and a student, the third patient I “helped” with, I actually had to help with. 14yo OD, pregnant and wanting to escape it all. She was not quite conscious, but not as far out as I saw later on. But she was fighting everyone trying to put a tube in, so the big kid got pointed out to hold her legs.
After that, it was a lot less panic, but a lot more uncertainty on my end. Compared to that kind of thing, finding a patient in bed barely alive was more about not being sure what to do, which is what made it worse for me. At least with a stroke, there wasn’t any uncertainty, no way I could screw up. Well, I guess that’s not true, but it felt that way.
I don’t envy the folks that deal with ODs regularly, much less a crisis shelter worker.
At the end of it all, there is no way after the fact to determine what the “correct” amount of narcan was for that situation.
It sounds like you’re actually saying that at the end, the correct amount was the amount it took to revive them.
The application of medication isn’t exact. There are many uncertain variables at play when someone is dying. It’s quite possible that its not the only reason the patient is crashing or they’ve taken what some call a ‘heroic’ dose and its simply wasn’t enough.
Yep, other conditions, other medications, who knows? And each person is unique.
As I understand narcan, it more assertively binds to the same receptors as opiods like fent, effectively blocking the body’s response.
But if it’s been long enough, the body has already reacted to enough of the first drug, so the second (narcan) can only do so much.
HEY!!! GET OFF LEMMY AND GET HIM A 3RD SHOT!!!
Yea we did I was being genorous it took 5 shots from the doctor to bring him out of it. When we gave the first two he was coding well. Thats when I posted this looking for help. But apparently it is just keep stabbing a patient full of the shit. Just never seen a person not come out of it after two shots.
I’ve seen 2 doses BARELY restore stable breathing (with oxygen support). Shits crazy
I personally put 4 needles in a young male community member… hip, shoulder, buttock…
When he came to within 3 minutes he was refusing medical treatment and literally running away.
Four days ago I found out from a former coworker/friend that he just OD’ed and died. His name was Riley B
Oh yeah. The narcan rage is real
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Is the patient in MODS?
MODs?
