Critical Care Scenarios

OCTOBER 11, 2023

Extremity neuro changes should prompt driving the MAP >90, naloxone, and IV steroids. Takeaway lessons We explore aortic dissection with Travis Hughes, vascular surgery fellow from the University of Kentucky, including classification, medical management, and nuances of the surgical perspective. Find us on Patreon here!

Naloxone 100

Naloxone Coronary OR 100

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

He awoke with naloxone. The 50-something patient with history of coronary stenting and slightly reduced LV ejection fraction. He had been smoking an opiate and suddenly collapsed. He was ventilated with BVM on arrival. This EKG was recorded as part of a standing order for critical care. He denied any CP or SOB. It does not radiate.

Overdose 52

Overdose OR Coronary ACS 52

The Overrun Podcast

JULY 3, 2019

Paramedics and EMTs can rescue patients with naloxone, but are we the right avenue to start people toward recovery? The State of New Jersey, in the throes of an enormous opioid epidemic, has unveiled allowing their Mobile Intensive Care Units (Paramedics) to administer buprenorphine as a part of an optional formulary. What does this mean?

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Mobile Intensive Care Unit Paramedic Naloxone EMT 52

Peter Canning

JANUARY 14, 2024

Here are some of the highlights: EMRs and EMTs may administer Naloxone IM in a dose of 0.4 Paramedics may administer buprenorphine to patient in precipitated withdrawal following naloxone resuscitation provided the patient meets required criteria and agrees to hospital transport.* mg via syringe.* micrograms/kg/min. .*

CPR 52

CPR Naloxone EMT EMT 52

ACEP Now

OCTOBER 15, 2023

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.

Emergency Department 52

Emergency Department Naloxone ALS OR 52

Dr. Smith's ECG Blog

MAY 5, 2023

The "good" news — Treatment with naloxone will probably resolve the bradycardia. These mathematical relationships of relative deflection size with absence of any deflection at all in lead I — are most commonly encountered when there is some type of artifact caused by movement or other interference originating from the Left Leg.

E-9-1-1 52

E-9-1-1 NARCAN Naloxone Overdose 52

ACEP Now

JULY 7, 2023

Patients with opiate overdose get naloxone. This month, we are discussing the medical management of patients with mild to moderate agitation. Emergency departments (EDs) focus on rapid initiation of medical treatment. Patients with sepsis get antibiotics. Patients in DKA get insulin.

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Emergency Department ED ALS Naloxone 52

The Good, The Bad & The Ugly Paramedic

MARCH 1, 2021

An accidental opioid overdose and its nemesis, naloxone. Every intervention that we introduce on emergency calls is intended to make a difference. Improve the situation in one way or another. Some will work and cause an effect that makes things better. Others will not, and may result in making things much worse.

Ambulance 52

Ambulance Paramedic Naloxone First Responder 52

Dr. Smith's ECG Blog

JULY 27, 2023

This 29 year old African American patient was found down, unconscious, not breathing and was given 2 mg of intranasal naloxone by a bystander. He then received bag-valve-mask ventilations for several minutes until he became responsive. He had a prehospital ECG that was worrisome to the medics, so they called me to see him at the door.

Coronary 52

Coronary ACS Naloxone Plasma 52

The Skeptics' Guide to EM

MAY 21, 2017

Do heroin overdose patients require observation after receiving naloxone? He is also the host of EMToxCast and gave a talk at the Association of Academic Chairs of Emergency Medicine Annual Retreat […] The post SGEM#179: Chase the Dragon and Naloxone first appeared on The Skeptics Guide to Emergency Medicine. Clinical Toxicology 2017.

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Naloxone Overdose First Responder BLS 130

Peter Canning

APRIL 18, 2025

We ask what medicine the mom gave him and she hands me what looks like intranasal naloxone. When I started as a paramedic we could only give naloxone intravenously (IV) or intramuscularly (IM). Recently I read the FDA just approved an intranasal epinephrine that also looks just like the naloxone and diazepam nasal sprays.

Epi Pen 52

Epi Pen Naloxone Epinephrine EMT 52

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].

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Naloxone Overdose Epinephrine ALS 169

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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Naloxone Overdose Emergency Medical Services Emergency Department 130

Peter Canning

SEPTEMBER 10, 2024

Across the nation states are passing initiatives to allow EMS services to leave naloxone kits on scene with at risk patients, their family, friends or bystanders. Each kit contains two 4 mg Naloxone intranasal devices, and instruction card for use, a CPR face shield, and instructions on how to access services. I think 50% is not bad.

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Naloxone EMS Overdose Emergency Medical Services 52

REBEL EM

JUNE 5, 2023

This study investigated whether it is feasible to initiate buprenorphine/naloxone in the form of “take home” packages containing low-dose and standard-dose inductions. REBEL Cast Ep117: Low-Dose vs Standard-Dose Take Home Buprenorphine From the ED Click here for Direct Download of the Podcast Paper: Moe et. PMID 33392580.

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Naloxone ED Overdose Emergency Department 95

The Skeptics' Guide to EM

AUGUST 27, 2022

He is successfully resuscitated using naloxone and is stable after an observation period. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. Case: A 24-year-old male presents to the emergency department (ED) after a fentanyl overdose.

Emergency Department 100

Emergency Department Naloxone Overdose ED 100

ACEP Now

JULY 7, 2023

While naloxone can treat fentanyl overdose, overdose symptoms may persist when xylazine is involved. Recently, Philadelphia has been reported as having the highest prevalence of xylazine, with xylazine present in 25.8 percent of all overdose deaths in 2020. Typically, xylazine is mixed with fentanyl.

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Overdose ALS Naloxone Emergency Department 98

Peter Canning

SEPTEMBER 19, 2024

In May, I speculated on some of the reasons for declining rates : Harm reduction and the availability of naloxone. Ten years ago when I responded to an overdose, I was the only one carrying naloxone. This doesn’t include all those resuscitations where bystanders gave naloxone and 911 was never called. We know what works!

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Naloxone Overdose First Responder OR 52

EM Basic

MARCH 13, 2019

DISCLAIMER : I’m not doing this episode to discredit those in law enforcement, the fire service, EMS, or any other first responders. I was an EMT-B in southeastern Pennsylvania for 10 years before starting my emergency medicine residency so I know how tough your jobs are on a daily basis. What is “Incidental Exposure”?

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Naloxone Overdose First Responder NARCAN 52

ACEP Now

DECEMBER 10, 2023

Though paramedics administered naloxone, he remained somnolent. You ultimately begin a slow naloxone infusion and admit him to the medical ICU. You question yourself for ordering IV potassium and starting a naloxone infusion, knowing you are causing discomfort for the patient who has known significant cancer-related pain.

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Naloxone Life Support Paramedic ALS 52

Peter Canning

OCTOBER 1, 2024

Is the decline in drug overdose deaths more related to the increased availability of naloxone, improved treatment for people who use drugs, or changes in the street drug supply, which while still quite toxic may be less so due to adulteration with other chemicals? A recent article in NPR, The pipeline of deadly fentanyl into the U.S.

Overdose 52

Overdose Naloxone OR 52

Peter Canning

MAY 22, 2024

Harm reduction and the availability of naloxone. Ten years ago when I responded to an overdose, I was the only one carrying naloxone. Now, half the time I arrive, the patient is already awake and talking, having gotten their naloxone either from family, bystander, or police or fire first responders. Graphics from CDC

Overdose 52

Overdose Naloxone First Responder OR 52

Peter Canning

OCTOBER 30, 2023

They overdose behind the dumpster where I give them naloxone and put them in the ambulance. They were injured physically or they were damaged mentally by abuse. They may have true mental health issues, often undiagnosed. They had access to drugs either through a doctor’s prescription or through a friend or the black market. Look at yourself.

Overdose 52

Overdose BLS EMT EMT 52

Peter Canning

JANUARY 20, 2024

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. Pinpoint. in 2020 to 8.6%

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Overdose Naloxone Firefighter First Responder 59

Peter Canning

DECEMBER 14, 2024

Widespread naloxone availability, increased harm reduction efforts and a focus on treatment, particularly medication assisted therapy may also be having a large impact on the declining death rate. In October of 2023, there were curious headlines out of Mexico that the Sinaola Cartel was getting out of the fentanyl business.

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Naloxone Overdose OR 52

Peter Canning

MARCH 5, 2024

EMS has a pivotal role in helping to combat these deaths, both but providing resuscitation with naloxone, but also in helping steer those resuscitated patients toward treatment and harm reduction resources. While the decline is good news, the number of people in our state (1217) succumbing to opioid deaths is still achingly high.

Overdose 52

Overdose Naloxone EMS OR 52

Peter Canning

FEBRUARY 7, 2025

My daughter Zoey had to do 25 hours of volunteer time for her school so I hooked her up with the local harm reduction drop in center, where she helped put together safe drug use kits as well as naloxone rescue kits. We talked about naloxone and how it was now available in pharmacies. Walgreens sold a generic Naloxone for $34.99.

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Naloxone NARCAN Overdose OR 59

ALiEM

JANUARY 6, 2025

Necrotizing fasciitis Case Question: Will naloxone reverse a xylazine overdose? Laboratory Data CBC : Hgb 2.74 (compared to baseline of 9.0); WBC count 17.39 BMP : Na 126; K+ 5.9; up from 0.69) ESR : >100 CRP : 15.94 However, fentanyl is the most common drug combined with xylazine.

NARCAN 141

NARCAN Overdose Naloxone Emergency Department 141

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. Upon arrival, his vitals were as follows: heart rate of 132 bpm, respiratory rate of 27, blood pressure of 134/75 mm Hg, and a SpO 2 of 100 percent.

NARCAN 89

NARCAN Naloxone Overdose Mental Health Services 89

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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Naloxone E-9-1-1 Overdose NARCAN 97

Peter Canning

FEBRUARY 13, 2025

ACMT & AACT Joint Position Statement on Nalmefene Should Not Replace Naloxone as the Primary Opioid Antidote at This Time. Fact: Newer synthetic fentanyls do not require more doses of naloxone than traditional to reverse an overdose. We don’t have that luxury. So I appreciate their opinion. What happened?

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Naloxone Overdose Emergency Medical Services EMS 64

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. Left lower lung field end demonstrates expiratory wheezing on auscultation. Other lung fields unremarkable. C or 100.4

E-9-1-1 98

E-9-1-1 ICU ACS EMS 98

Peter Canning

JANUARY 15, 2025

There was a great article in the CT Insider this morning about efforts in New Britain and Hartford Connecticut to connect with overdose patients and distribute naloxone throughout their communities. Ten minutes after I gave naloxone, the patient was up and talking to us. Pinpoint pupils, agonal breathing. They indicated they would.

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Naloxone Overdose NARCAN OR 52

Peter Canning

MARCH 12, 2025

Keep getting the naloxone out there. I expect US overdoses to decline longer before eventually plateauing to its 2017-2018 levels and/or rising several months behind Connecticuts progress. What should we be doing? Continue with harm reduction messaging. Be vigilant for an ever-changing drug supply that remains lethal.

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Overdose Naloxone OR 59

Peter Canning

MARCH 2, 2025

Health care providers and harm reductionists should keep on doing what they are warning people to never use alone and always have naloxone which works on carfentanil and all other opioids– readily available. Increased potency but less volume may mean less lethality than a drug with less potency, but much more volume in the mix.

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Overdose Naloxone OR 59

Peter Canning

APRIL 14, 2025

The man who had overdosed was quickly resuscitated with naloxone and by the time I arrived, he was alert and talking to the harm reduction worker there. I appreciated each instance. Democracy in action. I have had nothing but good experiences with legislators, both state and federal. This meeting went well too. It has good support.

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Overdose Naloxone Paramedic OR 52

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.

Overdose 52

Overdose Naloxone Emergency Department OR 52