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Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

Clinical impact: Rather than arguing with the patient about the likelihood of this phenomenon occurring and whether this is a true allergy, the patient is informed that they do not need to immediately start treatment to receive care in the hospital. Or one can start methadone induction. Journal of general internal medicine. 2017 Jun;32:660-6.

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ACMT Toxicology Visual Pearl: Needle to Necrosis

ALiEM

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]. PMID: 37014353 Ball NS, Knable BM, Relich TA et al. Xylazine Poisoning: A Systematic Review.

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REBEL Cast Ep117: Low Dose vs Standard Dose Take-Home Buprenorphine From the ED

REBEL EM

Background Information: Opioid overdose deaths have been increasing in the past twenty years. Clinical Question: Is low-dose take-home packages of buprenorphine/naloxone in the ED feasible compared to standard dose buprenorphine/naloxone? mg–naloxone 0.125 mg SL BID One-quarter tablet 2 Buprenorphine 1 mg–naloxone 0.25

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Overdose in the Elderly Increasing

Peter Canning

mg of Naloxone X 2, and now the ETCO2 drops to 45, the SAT soon comes up to 99 and the patient opens her eyes and lifts her head, surprised to find herself surrounded by EMS and Fire. Those efforts should include naloxone distribution, harm reduction information, and access to medication assisted therapy.

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Are Opiates Futile in Low Back Pain?

ACEP Now

After enrollment, patients were randomized either to a modified-release oxycodone-naloxone combination opiate, starting with an initial dose containing 5 mg of oxycodone, or placebo. The addition of naloxone to the tablets may also provide a confounder in terms of the analgesia provided.

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PSA: Incidental Skin and Inhalation Exposure to Fentanyl is NOT a thing!

EM Basic

I’ll be referencing this policy statement frequently and it’s worth a read as it succinctly and accurately presents all the information on this topic with evidence- not hysteria. Nothing happens, no one dies and no one needs naloxone. In these videos you see conscious and alert people asking for naloxone. We just clean it up.

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September 2023 News from the College

ACEP Now

Understanding how and why our biases work is an important first step in improving our decision-making, determining information we’re willing to trust, and building relationships. Did you know our brains are wired to take short cuts that sometimes lead to cognitive distortions?

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