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Not sure who to ask...however, I'm a tv scriptwriter on the…

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Not sure who to ask...however...
Not sure who to ask...however, I'm a tv scriptwriter on the soap opera Days of our Lives, and I've been asked to write a scene about someone (a nurse) who tries to commit suicide by od-ing. An EMT finds her before she's dead, tries to resuscitate her. The scene says they immediately start CPR but from what I've seen recently the first step would be a strong sternal rub, then cpr. Is that correct? And once they inducing vomitng and get the pills out of her stomach, they'd put her on an iv of fluids, yes? But what would her vitals be at that point. She has been 'saved', and gets into limited converation, but I just need the proper BP, etc. Help?
Submitted: 21 days ago.Category: Drug Testing
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5/30/2018
Drug Testing Expert: Dr. D. Love, Doctor replied 21 days ago
Dr. D. Love
Dr. D. Love, Doctor
Category: Drug Testing
Satisfied Customers: 19,645
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hello from JustAnswer. This is Dr. Love.

I believe that you are confusing two sternal procedures that are used for different things. A sternal rub is used to stimulate an unconscious patient to see if they can be induced into consciousness. It is essentially a painful (but safe) stimulus, and someone that does not respond is in a deeper level of sedation. However, a sternal rub does not help with resuscitation. A sternal thump, also called a precordial thump, is a forceful single pounding on the chest with a clenched fist to try to get the heart to come out of ventricular fibrillation, so is used during resuscitation. A precordial thump is used less now than was once true, because it has been largely supplanted by an AED (automatic external defibrillator).

What would happen would vary according to the clinical situation. CPR would only be considered if the person does not have breathing or a pulse. In that setting, there would not be any blood pressure, either. However, if the person has a pulse and blood pressure, but has a decreased level of consciousness (and they are trying the sternal rub to elicit a response), there would typically be a pulse and blood pressure, although the blood pressure is usually low and the heart rate is usually high.

In addition, they would typically not induce vomiting in someone that is not conscious person, as that person may aspirate vomitus into the lungs. However, yes, the EMTs would routinely start IV fluids.

If you want a scenario in which she is saved and able to communicate relatively quickly, it actually would be more medically accurate to use an antidote, and naloxone (brand name Narcan) would be the most feasible. Naloxone is an opioid antagonist. When someone overdoses on any opiate, the naloxone can immediately antagonize the effect. So, someone that is completely unconscious and poorly responsive to stimuli, including the sternal rub, will regain consciousness almost immediately after administration of naloxone, and would also be able to engage in conversation. By comparison, someone that is saved by CPR typically is unable to communicate shortly after resuscitation.

In addition, with the increasing numbers of opioid overdoses in the US, most states have passed laws allowing the drug to be available over the counter, and many facilities are encouraged to keep some available for emergencies in which someone is unconscious. Obviously, the EMTs would have naloxone, but if it would help your story line for a non-medical person to discover the nurse that took an overdose and intervene to save her, it could be done by the non-medical person administering naloxone.

If I can provide any additional information, please let me know.

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Customer reply replied 21 days ago
I don't have the freedom to write what I want, unfortunately. The EMT is about to leave his shift at the hospital and finds her in the on-call room, passed out on the floor. Starts CPR. Then she's kept in the on-call room rather than a hospital room as they know if it's discovered what she did, she could be fired, etc. So I'm stuck with that scenario. They say she had her stomach pumped, but if that happened, certainly someone else in the hospital would know. Could another nurse, a friend of hers, do it without anyone knowing? Hey, it's a soap opera. But I always like to be as accurate as possible! I know about Narcan as we see it used often on LivePD -- but would an EMT carry it on him?? But I have to get two scenes out of it! Could he find her, check her pulse, etc. see she has none and start CPR? Then when she comes to later, not have him say they pumped her stomach. WOULD they give her any Narcan following CPR or does that make no sense whatsoever?
Drug Testing Expert: Dr. D. Love, Doctor replied 21 days ago

From a medical perspective, this scenario is not realistic. An EMT or other nurse would typically alert the hospital system whenever someone needs resuscitation. Typically, CPR, by itself, does not successfully resuscitate someone; it helps to keep the person alive until advanced life support is able to resuscitate the person. It has started to change with the availability of AEDs, which can successfully resuscitate someone, but that is not CPR. Every hospital has a designated group of people that respond to such situations, and these people bring all that is necessary to provide advanced life support. They can be called by various names, but is most often called a Code Team. In addition, anyone that requires CPR and an AED or other advanced life support for resuscitation would typically not kept in the on-call room, as they typically need respiratory support for a while and close monitoring.

In no realistic hospital could an EMT or nurse perform all these things without other people knowing. However, if you do not have any choice in the scenario, then you may have to write an unrealistic scene.

An EMT would typically carry it in their kit that they carry with them. Narcan can reasonably be provided for an unconscious person if an overdose is suspected, including after CPR.

It is realistic for an EMT (or nurse) to find her, check her pulse, etc, see she has none, and start CPR, but that is also the point at which the EMT (or nurse) would alert others.

When we pump the stomach in someone that is not fully conscious, it is typically done by placing a large tube into the stomach, which avoids the potential risk of aspiration.

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Customer reply replied 21 days ago
You've been remarkably helpful, and maybe now see why some TV and films can be ridiculous. We're constrained by the sets and actors we can use! And, in this case someone else writers the narrative, then it's my job to turn it into script/dialogue. But when it's approved, changing it is an ordeal. If not impossible. Welcome to Hollywood. :)
Drug Testing Expert: Dr. D. Love, Doctor replied 21 days ago

I understand. This is why I tend to not watch medical dramas. I am sure that lawyers have the same issue with legal dramas and police officers with cop shows.

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Customer reply replied 21 days ago
You've been remarkably helpful, and maybe now see why some TV and films can be ridiculous. We're constrained by the sets and actors we can use! And, in this case someone else writers the narrative, then it's my job to turn it into script/dialogue. But when it's approved, changing it is an ordeal. If not impossible. Welcome to Hollywood. :) Oh -- I didn't mention that this EMT - one of our young hunks -- was a cop last year and shot someone who he thought was resisting (a black teen in a hoodie who happened to be a friend) and nearly died. The cop, deep in grief, set it up to kill himself as pennance, but was saved at the last moment by a friend. It was by gun, not drugs, but now he feels he's saving someone. And again -- soap opera.
Drug Testing Expert: Dr. D. Love, Doctor replied 21 days ago

I still think that the Narcan would be the most realistic scenario that could be done by one person following a sternal rub, be kept a secret, and he could still feel better about himself because he is saving someone. But you have to do what you have to do.

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Drug Testing Expert: Dr. D. Love, Doctor replied 21 days ago

Is there any further information that would be helpful?

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