Opioid Withdraw After Resuscitation

Opioid Withdraw After Resuscitation


Unintended Consequences of a Narcotic Resusciation

Dr. Donald Spaner

We can learn as much from our errors as we can from our success.  I share with you a case of multiple errors that we can all learn from.  This is not a judgement but a plea to remember we are entrusted with the care of human life.  It is an honor to be given this ability and we must never forget this.


48-year-old male reported by police to EMS, this is a well-known drug abuser who they were doing chest compressions on, after they administered 12 mg of Narcan intranasally.  He remains unresponsive and EMS correctly started to manage his airway with BVM.  An IV was established and he was given 2mg of Narcan IV.  Within a minute he was awake, fighting and could not be controlled.  The crew then administered an additional 2mg Narcan IV.  He became more violent and was now putting the crew and himself in immediate danger, including spitting with one of the crew members exposed to oral contamination.  They recognized the danger and chose to use Ketamine.  They gave 2 doses both IV and the sum of the dose was 400mg.  He also received 2.5mg Versed IV.  No glucose was checked during his care. Fortunately, his glucose was 140 on arrival at the ED   He arrived at the emergency department with snoring respirations as the staff managed his airway.  He was awake in 15 minutes and after observation was discharged from the emergency department.

There is certainly a lot to unpack here.

We all learn differently, and nothing is harder than learning things the hard way.  We need to sometimes take a deep breath and openly discuss our thoughts of care with our colleagues.  No emergency is so severe that we simply stop using our safety stops.  Remember in this situation there were 6 providers on scene caring for this man.  It does not matter if you are the junior medic or the EMT, if something doesn’t feel right, speak up.  This is a speak up culture and we all have a voice when it comes to doing what is best for our patients.  Thank you for your dedication, caring, empathy and professionalism.