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Should Narcan be on a brain stroke patient?

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Posted on Sat, 7 Jun 2014
Question: Should narcan be used on patient mostly non responsive (can not move) smell of alcohol, head trauma and right ear bleeding with head fracture? Possible stroke or anuerism
doctor
Answered by Dr. Sweta Singla (2 hours later)
Brief Answer:
no.

Detailed Answer:
Hi
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.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Sweta Singla (2 hours later)
This was used on my wife when she appeared to have a stroke and fell backwards. She seemed to be aware of what happen and where she was but could talk. She was air lifted to hospital and put in ICU. Vital signs were normal. How ever over next 2 days subarachnoid hemorrhage got worst and she passed away. My concern is did this narcan cause even more problems like raising the blood pressure, etc. My wife was fairly healthy, she could have been real dehydrated since they indicated her blood alcohol level was high. It's hard for me to believe it was as high as they reported at hospital. If you need more detail let me know.
doctor
Answered by Dr. Sweta Singla (11 hours later)
Brief Answer:
It depends on the clinical scenario....

Detailed Answer:
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.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sweta Singla (4 hours later)
The medic administered the narcan at the seen of fall. I am assuming the medic made this call knowing alcohol was involved and patient on blood pressure meds. Would not the narcan shoot up the blood pressure and could have a negative impact on the head trauma which at the time no definite injury was defined except possible fracture on right side of head and possible stroke?
doctor
Answered by Dr. Sweta Singla (2 hours later)
Brief Answer:
it may or may not

Detailed Answer:
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.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Sweta Singla (1 hour later)
The 911 medic administered narcan on site where my wife fell and hit her head prior to being air lifted to hospital, I think the medic probably made the decision to administer the narcan all along knowing that my wife had consumed alcohol and could have had a stroke and a serious head injury. First CT scan was done well over an hour later. It seems based on your reply it is possible the narcan could have caused or increased the size of SAH?

Sincerely
XXXX
doctor
Answered by Dr. Sweta Singla (2 hours later)
Brief Answer:
alcohol and trauma probably caused SAH

Detailed Answer:

I understand your concern. But, as we discussed earlier also, I think it is probably alcohol and trauma that caused Subarachnoid Hemorrhage.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Sweta Singla (6 minutes later)
but it is possible the narcan increased the blood pressure to a high which would not help the situation if anything would make worst?My wife was in good health, I don't think the fall caused this problem, all I am asking is it possible that the narcan administered could have caused or made the SAH worst?
doctor
Answered by Dr. Sweta Singla (37 hours later)
Brief Answer:
chances are exceedingly low....

Detailed Answer:
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.

Regards
Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Sweta Singla

Neurologist

Practicing since :2003

Answered : 74 Questions

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Should Narcan be on a brain stroke patient?

Brief Answer: no. Detailed Answer: Hi 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.