Should Narcan be on a brain stroke patient?
Thanks for your query.
Narcon is opioid antagonist and there is no indication of its use in brain trauma, stroke or comatosed patient. And the scenario you suggests the same. Thus I would suggest not to use it.
Hope it helps.
Let me know if I can assist you further.
It depends on the clinical scenario....
When subarachnoid hemorrhage happened it must have happened because possibly there was a aneurysm that must have ruptured because of either hypertension or trauma or deranged liver function and coagulation profile. The patient who is hypertensive initially to begin with will have a high BP because of the stroke as a compensatory mechanism and therefore patients are admitted in ICU so that BP can be monitored and controlled. Your doctor must have initially thought that alcohol level was high and that is also contributing to altered sensorium and so must have prescribed her Narcon. And it is difficult in such a scenario to pin point that the BP XXXXXXX because of Narcon though it may lead to increase in BP but unto what magnitude. In many hypertensive stroke (say in my practice 20-30%) patients in whom narcon is not used the BP is difficult to manage and is refractory to 3-4 antihypertenisve medicines. So it is difficult to blame narcon solely for increase in BP. SAH if it was associated with the pathological hypertension to begin with will have sustained high BP.
it may or may not
Again I would emphasize that it caused increased SAH size. First the first brain scan was done post narcon injection. And if subsequent brain scans which were done later during the course of illness showed increase in size so that increase would not be because of narcon as it will not lead to high bp. And I presume your medics must be strictly monitoring blood pressure considering the stroke.
chances are exceedingly low....
Though narcon can marginally elevate blood pressure, it is very, very unlikely to cause or worsen SAH. In my opinion the chances that Narcon aggravated her problem leading to mortality are exceedingly low. I would say they are in astronomical figures.
I understand you are grieved with what occurred and I am sorry for it. But I don't feel Narcon contributed to it.
Siting at the other end, without exact details of her ICU treatment I don't think I would add any value to this discussion. I suggest you to close this discussion if there are no more questions.