BS: Naxalone?

Subject: Naxalone?
From: Ringer
Date: 05 Feb 01 - 09:28 AM

Someone brought a newspaper cutting in to ringing practice last Friday. From Perth, Western Australia, it told the story of the Perth Millennium Project (it was an old cutting), which was to build a ringing tower with 18 bells (18! they never ring more than 16 together, but with the two "extra" semitones, they've got three different true rings of 12 bells. Awesome!). Anyway, on "opening night", there were apparently protesters outside, arguing that the money raised would have been better spent on (I'm quoting from memory here) "more homes for the homeless, more food for the starving and more Naxalone". Can anyone enlighten me as to what Naxalone is?

PS: I've replaced my stolen PC and got my cookie back. The really annoying thing is that it'll probably change hands for £20 in a pub, but replacing the window, blinds, and PC, and time spent with policemen, fingerprinters, alarm engineers, insurance agents, etc, will cost me the best part of a grand.

Subject: RE: BS: Naxalone?
From: Noreen
Date: 05 Feb 01 - 09:47 AM

Naxalone (Narcan)is a non-specific opioid antagonist, used for various reasons but possibly mentioned here in its role in reversing the effects of a heroin overdose? But who knows...

Sorry to here of your hassle over the PC, Bald Eagle.

Noreen

Subject: RE: BS: Naxalone?
From: Ringer
Date: 05 Feb 01 - 12:51 PM

Thanks for the prompt reply, Noreen.

Subject: RE: BS: Naxalone?
From: kimmers
Date: 05 Feb 01 - 01:16 PM

And it's really spelled 'nalaxone', brand name Narcan as stated above. Yes, it is extremely useful in the resuscitation of someone who has taken a narcotic overdose.

Subject: RE: BS: Naxalone?
From: Noreen
Date: 05 Feb 01 - 02:27 PM

Also spelled naxalone, kimmers, and possibly naloxone.

Noreen

Subject: RE: BS: Naxalone?
From: Mrrzy
Date: 05 Feb 01 - 02:29 PM

And here I thought it was something in the Aleve family - guess I wasn't that far off, now that I think about it!

Subject: RE: BS: Naxalone?
From: kimmers
Date: 05 Feb 01 - 02:36 PM

ah, naloxone... that's how I'm used to seeing it spelled. I knew I didn't have it quite right.

Subject: RE: BS: Naxalone?
From: Dave Swan
Date: 05 Feb 01 - 11:34 PM

Narcan (naloxone hydrochloride)is indeed a powerful narcotic antagonist, often used in cases of altered level of consciousness. Narcan, which can be admininstered intravenously, intramuscularly, intralingualy, or endotrachealy is, like glucose, one of those drugs which performs resurrections on the sidewalk.

In the early 1980's we administered Narcan via 2mg pre-loaded syringes. When poice officers saw the bright orange plunger of a Narcan pre-load depressed, they would watch the patient like a hawk to see whether or not he responded to the Narcan. Positive response to Narcan raised the index of suspicion for narcotic abuse.

The beauty of Narcan is its benign nature. The last time I checked, no allergic reactions to Narcan had been recorded. If you've no narcs in your system there's nothing for the Narcan to oppose, and you don't react to the Narcan at all. Further, Narcan blocks narcotic receptor sites and can prevent further narcotic intoxication.

A mark of a new paramedic is his fascination with the drug. He wants to awaken every drug overdose patient he finds with a full dose of Narcan, admininstered via rapid IV push. After a few waltzes on the pavement with a junkie who's just had his $20.00 high bummed by $0.50 worth of Narcan, the medic learns to administer just enough to keep his patient breathing but not enough to make him frisky.

When the medic's learned more, he administers the final awakening dose just before he turns the patient over to the emergency room nurse who's most recently jerked him around. Then she gets to do the pavement dance.

I hope Perth wants more Naloxone so they can short-circuit more overdoses.

Dave

Subject: RE: BS: Naxalone?
From: alison
Date: 06 Feb 01 - 07:15 AM

amazing to watch.... it works VERY quickly..... we use it frequently on babies who's mum's have had some pethidine too close to delivery (it crosses the placenta to the baby)... baby is born without much desire to breathe.... and gets narcan...... instant recovery....

slainte

alison

Subject: RE: BS: Naxalone?
From: Ringer
Date: 06 Feb 01 - 09:58 AM

Could easily have been Naloxone: as I said, I was working from memory. Many thanks, all.

Dave Swan: what is "intralingual"? Is it, as its etymology suggests, into the tongue? If so, how does it differ from intramuscular (isn't the tongue a muscle?)?

Subject: RE: BS: Naxalone?
From: alison
Date: 06 Feb 01 - 10:02 AM

Intrlingually I assume to mean through the tongue...... some medications are absorbed very quickly by putting them under the tongue (blood vessels very close to the surface).... eg the tablets or sprays for people who suffer from angina..... they work faster than Intramuscular

slainte

alison

Subject: RE: BS: Naxalone?
From: Dave Swan
Date: 06 Feb 01 - 08:46 PM

Some medications, (as alison suggests nitroglycerine is one of these) are absorbed quite quickly when placed under the tongue. This is the sublingual route.

Bald Eagle, you're right,the tongue is a muscle. In intralingual administration the tongue is lifted and the medication injected directly into its underside. You're pretty well assured the patient is out cold when he tolerates this. Intralingual administration is no longer indicated in our practice on the street. The reason we used to do this is that the uptake of the medication is rapid through this route and in a patient with scarred veins it provides easy access. Nowadays we manage the airway and wait for the intramuscular injection we've stuck in the arm to take effect.

Subject: RE: BS: Naxalone?
From: Mark Cohen
Date: 07 Feb 01 - 12:08 AM

As with the addicts Dave Swan was talking about, one needs to be careful when and how one reverses the effect of narcotics. Some years ago there was a big interest among intensive care physicians in using naloxone to treat septic shock. It seems that as the body systems are shutting down, there is an outpouring of endorphins (opioid compounds produced by the body) that tended to dilate capillaries and lower blood pressure as well as relieve pain, essentially helping us to slide swiftly and comfortably down the final slope. The reasoning went that if you could block those endorphin effects, you might keep the blood pressure up and have more time to treat the cause of the shock, and eventually save a life. As I recall, the attempts met with limited success.

I don't know what the current state of the art is. I do, however, remember a lecturer saying, "I don't know about you, but if I'm dying of septic shock and my body is trying to make my last moments pleasant and pain-free, the last thing I want is for some doctor to give me Narcan and make me fully awake and feeling all that terrible pain and fear right before I die." I think he had a good point. I don't know if this ever became standard treatment, but maybe someone out there does. Sometimes we in the medical field do well to remember the old maxim, "Primum non nocere" -- first, do no harm.

Aloha,
Mark

Subject: RE: BS: Naxalone?
From: Amos
Date: 07 Feb 01 - 12:16 AM

Dang, the things ya learn on the 'Cat!

A.

Subject: RE: BS: Naxalone?
From: Dave Swan
Date: 07 Feb 01 - 07:07 PM

Mark,

With respect to Narcan at life's end, we're begun to be more humane about its administration, at least in cases of the terminal patient has had the advantage of pain control meds.

We're much less apt to make sure someone is wide awake and full of tubes and needles at the end. When the family makes the panicked call as the patient's breathing becomes irregular and his level of consciousness declines, we're now allowed to spend time with the family, try to make the patient comfortable, and let nature take its course.

I haven't heard of the septic shock protocol in this area at anyone's level of practice.

As you say... Primum non nocere