Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Nurse here who has given Narcan a few times, none due to medical negligence. And I'm certainly not one to say negligence doesn't occur, as I've seen it first hand.

All the experiences I've had given it have been for reasons 2358 stated. They've been given an appropriate dose, maybe on the high end of appropriate but still ok, but are too sedated. I've never had to give it for respiratory distress, all the times have been basically because a patient becomes so sedated they aren't responding appropriately. Managing post op pain in elderly can be difficult.

I wouldn't immediately jump to medical negligence or respiratory problems. What he should do is request all his records so he has drug, dose, and time administered.

What does “intended side effects of narcotics” mean? If I’m reading your post correctly 2358’s unintended reference is what you’re saying where a patient receives the appropriate dosage but for whatever reason doesn’t respond well.

Also, if a patient is too sedated, are they not able to eventually come out of that state on their own?

TIA.

It’s not that the patient isn’t responding “well” per se it’s just whether the intended effect is achieved. Say morphine is administered to take the edge off of some pain but the effects are stronger than anticipated and the patient is falling asleep and totally out of it. It’s not that it’s bad or dangerous but the patient doesn’t need to be so sedated and so the effects need to be reversed. Sure, they would eventually come out of it on their own but that might not be ideal for whatever reason.

This is really interesting, I didn’t realize Narcan can be used that way. Are there any extra protocols that to be followed if narcan is given to someone that is oversedated? For example my understanding is you administer Narcan at home to your husband that ODs, he still should be immediately taken to the ER. Do the sedated patients end up with increased monitoring?

There’s a difference between administering Narcan to reverse an overdose at home or or on the street where you don’t know how much they’ve taken and administering a precise amount of naloxone in a clinical setting.

Anonymous wrote:

Anonymous wrote:Nurse here who has given Narcan a few times, none due to medical negligence. And I'm certainly not one to say negligence doesn't occur, as I've seen it first hand.

All the experiences I've had given it have been for reasons 2358 stated. They've been given an appropriate dose, maybe on the high end of appropriate but still ok, but are too sedated. I've never had to give it for respiratory distress, all the times have been basically because a patient becomes so sedated they aren't responding appropriately. Managing post op pain in elderly can be difficult.

I wouldn't immediately jump to medical negligence or respiratory problems. What he should do is request all his records so he has drug, dose, and time administered.

What does “intended side effects of narcotics” mean? If I’m reading your post correctly 2358’s unintended reference is what you’re saying where a patient receives the appropriate dosage but for whatever reason doesn’t respond well.

Also, if a patient is too sedated, are they not able to eventually come out of that state on their own?

TIA.

Sorry I'm half asleep with a cranky baby in my arm so hopefully my answer makes some sense. I misread pps post but even with narcotics part of the intended side effect is for the patient to have a somewhat sedative effect. The unintended side effect is that they become too sedated. And yes, at times they can come out of it on their own, but it's not really worth the risk. If a patient is simply obtunded or heavily sedated but their vital signs are intact, we aren't emergently acting. But its a bit of a bigger picture thing. If they are arousable and responsive but lethargic (picture someone still coming out of surgery) we will probably closely monitor. However if we are sternal rubbing them and they are minimally responsive or they aren't able to keep their eyes open, they run thr risk of deteriorating. And it's much less dangerous to treat someone who is obtunded vs someone who is obtunded and now is breathing slowlu and shallow, a HR that's getting lower, and a BP that's dropping.

Pain control is a very fickle thing because its impossible to determine what someone's pain level is. A patient who complains of 10/10 pain despite receiving meds and appearing to be resting comfortably can't be blown off because they dont appear to be in 10/10 pain.

I'd say 75% of the times I've been called to the bedside of a patient who has needed Narcan its because the patient is either elderly or has another condition which causes the meds not to process properly.
20% has been people who have taken illicit drugs as well or who have pocketed the pain meds and then taken a bunch at once
5% has been for no known reason.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Nurse here who has given Narcan a few times, none due to medical negligence. And I'm certainly not one to say negligence doesn't occur, as I've seen it first hand.

All the experiences I've had given it have been for reasons 2358 stated. They've been given an appropriate dose, maybe on the high end of appropriate but still ok, but are too sedated. I've never had to give it for respiratory distress, all the times have been basically because a patient becomes so sedated they aren't responding appropriately. Managing post op pain in elderly can be difficult.

I wouldn't immediately jump to medical negligence or respiratory problems. What he should do is request all his records so he has drug, dose, and time administered.

What does “intended side effects of narcotics” mean? If I’m reading your post correctly 2358’s unintended reference is what you’re saying where a patient receives the appropriate dosage but for whatever reason doesn’t respond well.

Also, if a patient is too sedated, are they not able to eventually come out of that state on their own?

TIA.

It’s not that the patient isn’t responding “well” per se it’s just whether the intended effect is achieved. Say morphine is administered to take the edge off of some pain but the effects are stronger than anticipated and the patient is falling asleep and totally out of it. It’s not that it’s bad or dangerous but the patient doesn’t need to be so sedated and so the effects need to be reversed. Sure, they would eventually come out of it on their own but that might not be ideal for whatever reason.

This is really interesting, I didn’t realize Narcan can be used that way. Are there any extra protocols that to be followed if narcan is given to someone that is oversedated? For example my understanding is you administer Narcan at home to your husband that ODs, he still should be immediately taken to the ER. Do the sedated patients end up with increased monitoring?

Over-medication certainly can result in death.

Anonymous wrote:

Anonymous wrote:Nurse here who has given Narcan a few times, none due to medical negligence. And I'm certainly not one to say negligence doesn't occur, as I've seen it first hand.

All the experiences I've had given it have been for reasons 2358 stated. They've been given an appropriate dose, maybe on the high end of appropriate but still ok, but are too sedated. I've never had to give it for respiratory distress, all the times have been basically because a patient becomes so sedated they aren't responding appropriately. Managing post op pain in elderly can be difficult.

I wouldn't immediately jump to medical negligence or respiratory problems. What he should do is request all his records so he has drug, dose, and time administered.

What does “intended side effects of narcotics” mean? If I’m reading your post correctly 2358’s unintended reference is what you’re saying where a patient receives the appropriate dosage but for whatever reason doesn’t respond well.

Also, if a patient is too sedated, are they not able to eventually come out of that state on their own?

TIA.

It’s not that the patient isn’t responding “well” per se it’s just whether the intended effect is achieved. Say morphine is administered to take the edge off of some pain but the effects are stronger than anticipated and the patient is falling asleep and totally out of it. It’s not that it’s bad or dangerous but the patient doesn’t need to be so sedated and so the effects need to be reversed. Sure, they would eventually come out of it on their own but that might not be ideal for whatever reason.

Requesting all medical records is an excellent suggestion from PP.

Anonymous wrote:Nurse here who has given Narcan a few times, none due to medical negligence. And I'm certainly not one to say negligence doesn't occur, as I've seen it first hand.

All the experiences I've had given it have been for reasons 2358 stated. They've been given an appropriate dose, maybe on the high end of appropriate but still ok, but are too sedated. I've never had to give it for respiratory distress, all the times have been basically because a patient becomes so sedated they aren't responding appropriately. Managing post op pain in elderly can be difficult.

I wouldn't immediately jump to medical negligence or respiratory problems. What he should do is request all his records so he has drug, dose, and time administered.

What does “intended side effects of narcotics” mean? If I’m reading your post correctly 2358’s unintended reference is what you’re saying where a patient receives the appropriate dosage but for whatever reason doesn’t respond well.

Also, if a patient is too sedated, are they not able to eventually come out of that state on their own?

TIA.

Not everyone reacts to opioids the same way, so even when a safe and calculated dose is administered for pain relief or sedation there’s sometimes more of a depressive effect than intended. So a reversal agent is used. It doesn’t mean he OD’d, stopped breathing, or that any staff was negligent.

Nurse here who has given Narcan a few times, none due to medical negligence. And I'm certainly not one to say negligence doesn't occur, as I've seen it first hand.

All the experiences I've had given it have been for reasons 2358 stated. They've been given an appropriate dose, maybe on the high end of appropriate but still ok, but are too sedated. I've never had to give it for respiratory distress, all the times have been basically because a patient becomes so sedated they aren't responding appropriately. Managing post op pain in elderly can be difficult.

I wouldn't immediately jump to medical negligence or respiratory problems. What he should do is request all his records so he has drug, dose, and time administered.

If you’re one of the 250,000 dead people,
it’s a big deal to your loved ones.

Naloxone is used to reverse intended or unintended effects of opioids, not just overdoses, such as during sedation. It’s not a big deal.

I received “narcan” after I had a bone set in the ER and was given morphine. It is sometimes given to avoid the undesirable side effects of an opioid. There was no overdose, I just briefly needed the morphine, and then I didn’t. Narcan. Done and done.

Anonymous wrote:

Anonymous wrote:
Johns Hopkins University says “Avoidable Medical Errors” are the third leading cause of death (greater than 250,000 per year) after heart disease and cancer.

“The CDC’s way of collecting national health statistics FAILS to classify medical errors separately on the death certificate.”


Yikes!!!!!

Ok, well OP's FIL didn't die.

250,000 people each year going to a hospital to get better, do die.... as a direct result of preventable medical error. This is outrageous.

Anonymous wrote:

Anonymous wrote:This is not uncommon in the hospital setting esp when titrating pain meds or if the patient has a pca. I don’t think this necessarily means there was a medical error.

You seem confused.

PP is not confused. Administering reversal agents in a hospital is not rare and it doesn’t mean a medical error has occurred.

Come back when you’ve finished your anesthesia residency

Anonymous wrote:Well that means he stopped breathing

No, that is not “what that means.”

— person who administers naxolone for a living as part of her profession