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This 29 year old African American patient was found down, unconscious, not breathing and was given 2 mg of intranasal naloxone by a bystander. On arrival to the ED, the patient was diaphoretic, tachycardic. I did not think it was due to ACS, but we ordered an ED ECG immediately: What do you think? and had dilated pupils.
In the field, he was given 4 mg intranasal (IN) naloxone and rescue breaths via bag valve mask. In the ED, he develops recurrent respiratory depression and hypoxia to 80%. He is administered 2mg intravenous (IV) naloxone and shortly after develops precipitated withdrawal with altered mental status, diaphoresis, vomiting, and diarrhea.
SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Haematology specialist clinics are key to manage the chronic side of the disease, while ED doctors should be able to act rapidly on the common acute emergencies.
A 33-year-old male with a history of drug use presented to the emergency department (ED) for extreme agitation after receiving two doses of 2 mg naloxone by EMS for respiratory depression. If available, an in-house ED pharmacist is an incredible resource for guidance when there are questions regarding pharmacologic management.
While this guide isnt exhaustive, its designed by residents, for residents, to provide practical tips and foundational knowledge thats crucial in the fast-paced, high-stakes environment of the ED. Introduction Airway management is a critical ED skill to master. Figure 7: (modified from Tanoubi 2009).
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