Three Potentially Life Saving Techniques You Should Know

Narcan. Epipen. CPR.

An unresponsive young man lying on the floor, no longer breathing, at a high school party where pills are unknowingly laced with fentanyl.

A child with a food allergy, at a sleepover party, who suddenly develops hives, swollen lips, and a sense of panic.

An elite football player who is tackled hard, gets up, and then drops limply to the turf, unconscious and without a pulse.

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In primary care, we spend most of our time trying to prevent, diagnose, and treat medical problems that are chronic and not immediately life-threatening. Yet part of our job is to think ahead and help prepare for moments when people might step up and heroically save a life. That life could be their own. Or it could be the life of a friend, family member, or random fellow human being. In the past year alone, I have had patients saved by all three of the following tactics. If they were not personally prepared, or some other prepared hero had not stepped up in time, their lives would have been lost.

We should be familiar with Narcan for opioid overdoses, Epipen for anaphylactic reactions, and compression-only CPR for sudden cardiac arrest.

I hope this post will be a good starting point for these 3 heroic measures rather than a comprehensive resource. To make it easier I have curated a few videos that present the essentials and provide a good starting point that can lead to preparatory action. I hope we never need to use any of these techniques… but was there ever a more salient motto than: Be Prepared?

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Narcan

Knowing about Narcan, and being prepared with a simple nasal spray device, is particularly important to consider for anyone who takes prescription opioids or has a history of opioid abuse. Any teenager or young adult who goes to parties needs to be careful. Hey, try this Adderall I got. It could unwittingly be counterfeit and laced with fentanyl. The American opioid crisis is getting worse, and most of us live in communities that have been affected to some degree. About 106,000 people died in the U.S. last year alone, with the sharpest rise occurring in males.

Death from synthetic opioids like fentanyl have accounted for the majority of recent increases in mortality and lethality.

Solutions to this crisis are not easy, and are well beyond the scope of this post. We are thinking small here, but heroically. Narcan/naloxone is an easily administered nasal spray that can reverse the life threatening effects of opioids in someone who is unresponsive and suspected of overdose. According to the CDC: “all 50 states and the District of Columbia allow pharmacists to dispense naloxone without a prescription.” Here are detailed fact sheets about Narcan.

Should teens and young persons carry Narcan to parties? Is it something we might arm them with, both to rescue themselves and others? With adverse effects being so minimal, many have argued that moms and dads need to helicopter in and be proactive: “It’s safe. Your town will probably give it to you for free. If you have a teenager, don’t wait.”

I called a couple local pharmacies in New Jersey and Philly, and spoke to one of my patients who is a pharmacist this week. They stated that people can either show up at the pharmacy and request Narcan, or bring a doctor’s prescription, and the cost will vary from $0 to $125 depending on health insurance coverage. Most pharmacists can dispense Narcan without a doctor’s prescription due to a standing order from the state.

If you type into Google: “Free Narcan in [insert your state here]” you should be able to find additional ways to get a supply… but the local pharmacy seems like the best starting point. A lot of my subscribers might find these links helpful in Philly (1, 2) and Jersey (1, 2), but you get the idea. Where there is a will, there is increasingly a way.

Here’s how to administer Narcan:

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Epipen

Anaphylactic reactions are terrifying to experience and behold. They can be fatal. Fortunately a timely injection of epinephrine can reverse the closure of airways and flooding of lungs… and save a life. Bee stings, medications, and foods are the most common triggers I see in my practice. Among children in school, 1 out of 13 has a potentially anaphylactic allergy. This has been increasing in prevalence for various reasons. Now that’s an average of 2 kids per class.

For someone with a life-threatening allergy, carrying an Epipen or similar device (Auvi-Q, generics) is an absolute must. Family members and friends should be familiar with how these work, especially if the child/person is unable to self-administer in that moment of desperation. Honestly, we should all be aware. Albeit daunting, it is so easy, as the following videos demonstrate.

And from my little personal soapbox here, I’ll state as an aside that it is completely unacceptable for a school transportation service to state that their drivers are not trained in using Epipens. Any little kid with a food allergy is on her own. I’ve had some passionate conversations, even with some teachers, about the importance of education, diligence, and the courage to step up awareness. I’ve also been let down by a world class children’s hospital who misdiagnosed an obvious, first-time anaphylactic reaction in my child. It’s just a viral rash. For some unfathomable reason, people downplay, deny, and even disrespect anaphylactic allergies all the time. As if it is a kind of crying wolf to remain vigilant all the time.

So - when in doubt with an evolving allergic reaction, just do it. Give Epi. This testimonial from a woman named Heather Braverman chillingly recounts why this is true. And when your doctor insists on refilling your Epipen, even if you’ve never needed to use one, accept the yearly refill and carry it at all times.

And here is how to do it.

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Compression-Only CPR

Even before the pandemic, the prospect of giving a total stranger mouth-to-mouth resuscitation as part of CPR involved some instant intimacy that most people would shy away from. Fortunately, just giving compressions until help arrives or defibrillation can be performed has been found to work almost as well. According to the American Heart Association:

With 70 percent of all out-of-hospital cardiac arrests happening at home, if you’re called on to perform Hands-Only CPR, you’ll likely be trying to save the life of someone you know and love. Hands-Only CPR carried out by a bystander has been shown to be as effective as CPR with breaths in the first few minutes during an out-of-hospital sudden cardiac arrest for an adult victim.

Taking a CPR course is a great way to be prepared, and to learn or relearn full CPR including rescue breaths. There are cheap, pocket-sized CPR masks with one-way valves that provide a safer barrier. But until that time, there is this video that takes less than 3 minutes of our present to review the basics:

CPR absolutely saved the life of NFL player Damar Hamlin on national TV. It also saved the life of one of my healthier patients about a month ago when she suddenly and unexpectedly went out. And with long-term cardiovascular risks increasing in the age of Covid, sudden cardiac events are forecast to be more common than we would care to admit. It’s already happening.

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In Conclusion

Heroic measures in life-threatening situations are high impact, low probability events. Nonetheless, with some passive video watching, and some gentle prodding, we can prepare ourselves to help others… and potentially ourselves. Consider getting Narcan and knowing how to use it, especially if you have family members at risk of overdosing, overmedicating, or just being careless as social kids/young adults. Know about Epipens and anaphylaxis, especially if you have children (or their friends) affected by food allergies, or you have a serious allergy yourself - carry epinephrine at all times, and refill when expired. And finally, CPR does save lives, and can be as easy as calling 911 and performing chest compressions. A real CPR course is best, but until then, or if performing on a stranger and not feeling up to giving rescue breaths, the compression-only technique has been validated in the short run.

And may your preparations be gratefully unnecessary.