Question: My question relates to narcan. Do you feel it is necessary in all cases to check BGL prior to administering narcan? The Medical Directive reads uncorrected hypoglycemia as contraindication but in the presence of no diabetic history and an incident history which is clearly indicating opioid overdose combined with critically low oxygen saturation and no ability to ventilate are we to invariably to take a BGL prior to treating obvious signs and symptoms of opioid overdose or can we use clinical judgement based on findings? It goes without saying that a BGL should eventually be taken on such a patient at some point but my question is with a critical patient, no history or finding consistent with low BGL and multiple indicators for OD are we not safe to presume OD, treat accordingly and follow up with BGL afterwards to rule out hypoglycemia?
This is a good question to ask. It illustrates the complexity of practice in the real world. The reality of practice is that in emergent situations practitioners do multiple things simultaneously. If there is no urgency to treat the overdose (you are able to ventilate easily etc.) it is reasonable to have your partner obtain the blood glucose while you are assisting ventilations of the patient. If everything points to a narcotic overdose AND there is no indication the patient is a diabetic taking hypoglycemics AND the patient is unstable, it is reasonable to administer Naloxone prior to obtaining a blood glucose determination. As you stated in the question, a blood glucose should be obtained as soon as possible but the priority is to stabilize the patient