The Skeptics' Guide to EM

AUGUST 27, 2022

He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. […] The post SGEM#374: Bad Habits – Medications for Opioid Use Disorder in the Emergency Department first appeared on The Skeptics Guide to Emergency Medicine. Date: August 23rd, 2022 Reference: Schoenfeld et al.

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ALiEM

NOVEMBER 29, 2023

Naloxone will not reverse the effects of xylazine; however, it is routinely given in unresponsive or obtunded patients presenting with an opioid toxidrome. In patients with minimal response to naloxone, xylazine toxicity may be suspected [10]. Opioid overdoses involving xylazine in emergency department patients: a multicenter study.

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The Skeptics' Guide to EM

JANUARY 19, 2019

Hospital Observation Upon Reversal (HOUR) With Naloxone: A Prospective Clinical Prediction Rule Validation Study. Hospital Observation Upon Reversal (HOUR) With Naloxone: A Prospective Clinical Prediction Rule Validation Study. Sixty minutes after receiving naloxone he is GCS 15 and walking to the desk demanding to be discharged.

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REBEL EM

JUNE 5, 2023

One study from a county in Massachusetts found that of all nonfatal opioid doses seen in the emergency department from 2011-2015, 1 in 20 patients subsequently died within one year of initial visit with 66% of these deaths being directly related to an opioid overdose (4). mg SL BID One-half tablet 3 Buprenorphine 2 mg–naloxone 0.5

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ACEP Now

JULY 7, 2023

CASE A 30-year-old woman presents to the emergency department with left arm pain from a chronic wound. While naloxone can treat fentanyl overdose, overdose symptoms may persist when xylazine is involved. Opioid overdoses involving xylazine in emergency department patients: a multicenter study. Alexander RS, et al.

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ACEP Now

DECEMBER 10, 2023

A middle-aged male with squamous cell carcinoma and extensive metastases is brought to the emergency department (ED) after being found unresponsive following a believed suicide attempt (SA) by methadone ingestion. Though paramedics administered naloxone, he remained somnolent. You order IV potassium and magnesium.

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ALiEM

JANUARY 6, 2025

The pain worsened today, prompting him to come to the emergency department for evaluation. Necrotizing fasciitis Case Question: Will naloxone reverse a xylazine overdose? The patient reported a wound to his left leg that had become larger over the past 5 months. BMP : Na 126; K+ 5.9; up from 0.69) ESR : >100 CRP : 15.94

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ACEP Now

FEBRUARY 11, 2025

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. That is, they experienced nausea, vomiting, chills, myalgias, and diarrhea.

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EMDocs

JANUARY 22, 2025

In the field, he was given 4 mg intranasal (IN) naloxone and rescue breaths via bag valve mask. He is administered 2mg intravenous (IV) naloxone and shortly after develops precipitated withdrawal with altered mental status, diaphoresis, vomiting, and diarrhea. When should a naloxone infusion be considered?

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EMDocs

JUNE 27, 2024

mg q20-30 min per dose) PRN naloxone in case of respiratory depression Some patients have SCD crises pain plan for reference Antimicrobials 11 Ceftriaxone + azithromycin if penicillin allergy for both children and adults. C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1

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Peter Canning

DECEMBER 6, 2024

There has been much speculation and the answer probably doesnt lie with one factor but with many, including increased availability of naloxone, the efforts of harm reduction workers, the end of the COVID isolation, the trend away from injecting to snorting or smoking, a less toxic drug supply, and expanded treatment.

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Core EM

JANUARY 16, 2025

naloxone), the person is likely to get intubated. Engagement of the Median Glossoepiglottic Fold and Laryngeal View During Emergency Department Intubation. Ann Emerg Med. ” Academic Emergency Medicine 26.9 Ann Emerg Med. Reverse loading to facilitate Glidescope intubation. 2007): 161-162.

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Don't Forget the Bubbles

JULY 5, 2023

Naloxone (opioid antidote) should be available in ED in case of severe respiratory depression. A 6-year-old girl from Saudi Arabia was referred by her General Practitioner to the local emergency department. In addition to opiates, continue to offer paracetamol and NSAIDS (unless contraindicated).

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