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SGEM#453: I Can’t Go For That – No, No Narcan for Out-of-Hospital Cardiac Arrests

The Skeptics' Guide to EM

Date: September 18, 2024 Reference: Dillon et al. Reference: Dillon et al. Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Network Open. August 20, 2024 Guest Skeptic: Dr. Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque.

Naloxone 260
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POCUS findings of hemodynamically unstable PE with cardiac arrest

EMDocs

The Accu-Chek was 214, and there was no response to empiric Narcan administration. Alerhand et al described ten individual echocardiographic findings of RV strain that suggest PE. VUMC Emergency Medicine, “RV Strain & TAPSE” YouTube Video [link] Farcy et al. 10,11 Vid 1. TAPSE motion normal.

ED 98
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An Unusual Bradycardia

Dr. Smith's ECG Blog

Narcan was not given at the scene. The patient was a 20-something woman who was found poorly responsive with altered mental status in her car. Numerous needles from self-injection of opioids were found in the car. There was no indication of hyperkalemia.

E-9-1-1 52
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SAEM Clinical Images Series: Xylazine Wounds

ALiEM

No, xylazine is a non-narcotic drug and is not an opioid, thus, Narcan will not specifically reverse acute xylazine intoxication. Thus, Narcan is reasonable to administer in the setting of a suspected overdose since the patients presentation can be due to combined use. References Papudesi, Bhavani Nagendra, et al.

NARCAN 141
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Case Report: Acute Kratom Withdrawal

ACEP Now

In the acute setting, it is postulated that withdrawal may be brought on by the rapid reversal and displacement of opioid receptors from drugs such as naloxone (Narcan). Gummin DD, Mowry JB, Beuhler MC, et al. Todd DA, Kellogg JJ, Wallace ED, et al. Obeng S, Kamble SH, Reeves ME, et al. link] Accessed December 4, 2024.

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ToxCard: Naloxone – Pearls and Pitfalls

EMDocs

DOI: [link] O’Donnell J, Tanz LJ, Miller KD, et al. Al-Azzawi M, Alshami A, Douedi S, Al-Taei M, Alsaoudi G, Costanzo E. Available at: [link] October 19, 2023 Kelly A, Kerr D, Dietze P, et al. PMID: 15651944] Robertson TM, Hendey GW, Stroh G, et al. PMID: 19731165] Product Information: Narcan(R), naloxone.