tol is Tolerance.
Is the patient in MODS?
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
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.
