The Skeptics' Guide to EM

MAY 21, 2017

Do heroin overdose patients require observation after receiving naloxone? Do heroin overdose patients require observation after receiving naloxone? Opioids depress the heart rate and breathing and overdoses can result in death. The second new recommendation was about opioid overdose treatment. Clinical Toxicology 2017.

Naloxone 130

Naloxone Overdose First Responder BLS 130

The Skeptics' Guide to EM

JANUARY 19, 2019

The EMS crew observes drug paraphernalia and suspect an intravenous (IV) opioid overdose. Background: There have been close to 400,000 deaths from an overdose involving any opioid (prescription and illicit opioids) between 1999 and 2017. [1] Wave 2: Rapid increase in overdose deaths involving heroin starting in 2010.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

Peter Canning

JANUARY 20, 2024

I have called the time on a number of her neighbors in this building, some of them victims of overdose. While the news often focuses on the dangers of fentanyl to youth, what I see on the street and what the data shows is that the group that is seeing the biggest increase in overdoses is the elderly. of all overdoses to 11.1%.

Overdose 59

Overdose Naloxone Firefighter First Responder 59

ALiEM

FEBRUARY 5, 2024

These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Take the AIR Toxicology Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

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

Drug overdose deaths are down 3.1% 107,543 people died of drug overdoses in 2023 down from 111,029 in 2022. Here in Connecticut, drug overdose deaths have been decreasing for the last two years (down 14% in 2023 from the 2021 high). Ten years ago when I responded to an overdose, I was the only one carrying naloxone.

Overdose 52

Overdose Naloxone First Responder OR 52

REBEL EM

OCTOBER 16, 2024

Take Home Points Orogastric lavage may still play an important role in treatment of the overdose patient. Strongly consider orogastric lavage in a patient who has taken an overdose of drugs that are particularly toxic, suspected extreme doses associated with high morbidity/mortality and do not have easily available and effective antidotes.

Overdose 105

Overdose EMS OR 105

ESO

DECEMBER 18, 2024

In 2023, EMS clinicians responded to 236,000 calls for suspected opioid overdoses, representing nearly 2% of all EMS calls nationwide. The 2024 ESO EMS Index reveals that 82% of patients with suspected opioid overdoses received naloxone, a medication that can reverse opioid effects. Gender disparities were also found.

Naloxone 52

Naloxone CPR Overdose Defibrillator 52

FOAMfrat

DECEMBER 26, 2024

Unlike other methods, such as firearms, hangings, intentional overdoses, and cutting, chemical suicides tend to linger in the area where the act was committed. TRIGGER WARNING: TOPICS OF SUICIDE MAY BE HARD FOR SOME PEOPLE TO READ ABOUT. THIS ARTICLE IS COVERING THE MEDICAL ASPECTS OF CHEMICAL SUICIDES.

Epinephrine 116

Epinephrine First Responder OR Emergency Manager 116

International Journal of Paramedicine

MARCH 15, 2025

A meaningful portion of patients used opioids for pain management, with a subset identified at high risk for opioid misuse or overdose. Results: Analysis of 435 patient screenings revealed notable findings. While most patients stored medications safely, disposal practices varied, highlighting a need for education and intervention.

Paramedic 52

Paramedic Community Paramedicine Paramedicine Paramedicine 52

The Skeptics' Guide to EM

APRIL 20, 2024

With the 2014 CDC declaration that prescription drug overdose is one of the five top health threats, there has been a movement away from opioids as the mainstay of pain management for rib fractures [6].

Emergency Department 215

Emergency Department Overdose ALS ED 215

EMDocs

JANUARY 4, 2024

Questions: What are the clinical manifestations of bupropion overdose? How is bupropion overdose treated? How long should a patient be observed after a bupropion overdose? 1 In addition to intentional overdoses, there are multiple case studies of abuse (ingestion, insufflation, injection). hours, SR 3 hours, XL 5 hours.

Overdose 94

Overdose E-9-1-1 ALS Emergency Department 94

Peter Canning

MARCH 5, 2024

Connecticut opioid-related deaths declined for the second year in a row, down 14% from their 2021 high of 1431 opioid deaths, according to the latest statistics from the Connecticut Office of the Medical Examiner (OCME). Opioid deaths represented 92% of all overdose deaths in Connecticut.

Overdose 52

Overdose Naloxone EMS OR 52

EMergucate

NOVEMBER 13, 2012

Cinchonism = toxidrome caused by quinine or cinchona bark overdose Signs and symptoms: tinnitus, impaired hearing blurred vision headache vertigo … Continue reading →

Overdose 100

Overdose OR EMS 100

ACEP Now

JULY 7, 2023

Xylazine is a veterinary sedative that has been increasingly implicated in overdose deaths throughout the United States. percent of all overdose deaths in 2020. 1 Known by street names such as “tranq,” “tranq-dope,” or “zombie drug,” xylazine is increasingly found in patients with opioid overdose. Drug and Alcohol Dependence.

Overdose 98

Overdose ALS Naloxone Emergency Department 98

EMDocs

AUGUST 3, 2023

IV is usually recommended due to faster onset, ease of administration, and shorter protocol duration. These local protocols vary from the labeled dosing; contacting and using your local poison center’s protocol is recommended. These local protocols vary from the labeled dosing; contacting and using your local poison center’s protocol is recommended.

Overdose 98

Overdose E-9-1-1 OR ED 98

EMDocs

JANUARY 17, 2024

What are the treatment options for a benzonatate overdose? 7) Overdose literature review timeline: In 1986, the first two benzonatate fatalities were reported in the literature: a choking infant and an intentional overdose in a teenager. (8) Questions: What is benzonatate’s mechanism of action?

E-9-1-1 92

E-9-1-1 Overdose Emergency Medical Services Life Support 92

Pediatric EM Morsels

OCTOBER 27, 2023

Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Krug 2007] What If the Child is Obese or Emaciated? of children; PAWPER predicted within 10% for 89.2% Validation study done in Italy.

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

The Skeptics' Guide to EM

AUGUST 27, 2022

Case: A 24-year-old male presents to the emergency department (ED) after a fentanyl overdose. You are interested in seizing this opportunity to offer some type of help to this patient to prevent another opioid overdose in his future. He is successfully resuscitated using naloxone and is stable after an observation period.

Emergency Department 100

Emergency Department Naloxone Overdose ED 100

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

He had been smoking an opiate and suddenly collapsed. He was ventilated with BVM on arrival. He awoke with naloxone. This EKG was recorded as part of a standing order for critical care. He denied any CP or SOB. An EKG was repeated at 5 minutes The T-wave is less hyperacute. Maybe there is some spontaneous reperfusion? It does not radiate.

Overdose 52

Overdose OR Coronary ACS 52

REBEL EM

JUNE 5, 2023

Background Information: Opioid overdose deaths have been increasing in the past twenty years. The national number of overdose deaths from any opioid has increased 62.5% In addition, buprenorphine has a lower risk of death from overdose when compared to methadone (2). mg tablet) 1 Buprenorphine 0.5

Naloxone 94

Naloxone ED Overdose Emergency Department 94

Silk City Blog

JUNE 2, 2022

While it is generally safely used, overdose can result in the development of liver failure due to APAP’s hepatotoxic metabolites. Hepatic necrosis is preventable in overdose with timely administration of N-acetyl-cysteine (NAC) which restores glutathione reserves, allowing for safe excretion of these hepatotoxic metabolites.

Overdose 40

Overdose EMS OR 40

The Skeptics' Guide to EM

AUGUST 18, 2018

Exclusions: Non-English speaking and no translator with patient, violent behavior, intentional overdose, needlestick injury or sexual assault, previously enrolled, presented for a scheduled revisit, direct transfer to an admitting service, fast track patient, left against medical advice prior to seeing physician and pharmacist.

Emergency Department 130

Emergency Department Overdose ED ALS 130

University of Maryland Department of Emergency Med

APRIL 10, 2023

Glucagon therapy in beta blocker and calcium channel blocker overdose is controversial and no high level evidence is available to support or. Click to view the rest

Overdose 40

Overdose OR 40

Dr. Smith's ECG Blog

JULY 25, 2024

As demonstrated by Dr. Smith in his above discussion — Application of the ECG findings in Figure-1 to today's clinical scenario ( ie, marked sinus tachycardia in this younger adult with drug overdose and respiratory arrest ) — provides an immediate and much more likely explanation for DSI than trying to postulate ACS.

Defibrillator 124

Defibrillator Coronary Epinephrine ACS 124

Pediatric EM Morsels

JUNE 16, 2023

Sometimes this can be used to our advantage, like when we need to give subcutaneous fluids to a dehydrated patient without an IV, or when we need to give SQ medications for things like Sulfonylurea overdose , Hereditary Angioedema , or DVTs. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Overdose 154

Overdose OR Critical Care ALS 154

Core EM

JULY 23, 2024

Hyperkalemia, Sodium-channel blockade (ex: tricyclic acid overdose), Pre-excitation syndromes (ex: Wolff-- Parkinson-White syndrome), Aberrant conduction (ex: bundle branch blocks), Ventricular-Paced beats, Hypothermia, Ventricular ectopy What immediate interventions should be considered based off of this initial ECG?

Plasma 130

Plasma Emergency Department Overdose OR 130

FOAMfrat

JUNE 3, 2024

Right as you’re making your bunk you get dispatched for a reported overdose with police enroute, no further information. We go into it with preconceptions of what to expect: “It’s a simple heroin overdose, we’ll wake them up and they’ll refuse, then we’ll go back to bed”. We’ve all had this call before, right? You can bet that I was!

Overdose 98

Overdose Ambulance First Responder ALS 98

EMDocs

FEBRUARY 15, 2024

7,10 Contraindications include asthma, chronic obstructive pulmonary disease (COPD), genitourinary or gastrointestinal obstruction, or if there is suspected or confirmed tricyclic antidepressant (TCA) overdose. No specific laboratory finding confirms if a patient has ingested a plant. Physostigmine does not reverse seizures or dysrhythmias.

E-9-1-1 111

E-9-1-1 Overdose ED OR 111

EMDocs

JANUARY 23, 2024

An inciting event will typically push them over the edge into BRASH syndrome: Dehydration Hypotension from sepsis or another condition GI illness Dosage increase of a chronic medication (e.g., beta blocker) New medication (e.g., NSAID or potassium sparing diuretic) Ask the following: Is there mild hyperkalemia? Is there some renal injury?

Epinephrine 115

Epinephrine Overdose OR 115

Core EM

JANUARY 24, 2024

Hyperkalemia, Sodium-channel blockade (ex: tricyclic acid overdose), Pre-excitation syndromes (ex: Wolff-- Parkinson-White syndrome), Aberrant conduction (ex: bundle branch blocks), Ventricular-Paced beats, Hypothermia, Ventricular ectopy What immediate interventions should be considered based off of this initial ECG?

Plasma 130

Plasma Emergency Department Overdose OR 130

Medgadget

JULY 7, 2022

For instance, they investigated it in the context of acetaminophen overdose in mice, which results in liver damage. However, delivering it to the gastrointestinal tract to treat inflammatory diseases, such as colitis, is a challenge. Carbon monoxide is typically considered a hazardous gas. .

Overdose 99

Overdose OR 99

Critical Care Scenarios

JANUARY 4, 2023

Simple intoxications like baclofen overdose can cause incredibly dense coma. . * Give thiamine indiscriminately and widely to patients with altered mental status; it is harmless and Wernicke-Korsakoff may fool you. Start with the history and meds. Inquire as to recent history of behavioral changes, neurologic phenomena, illness, etc.

Overdose 100

Overdose OR 100

Emergency Medicine Cases

DECEMBER 20, 2023

Heart rate/rhythm: consider antidotes for brady/tachy-arrhythmias, and for sinus tachycardia consider fluids for vasodilation and benzodiazepines for agitation. Electrical conduction and axis: consider sodium bicarb for QRS > 100 especially if RBBB or terminal rightward shift, and magnesium for QTc> 500.

Coronary 230

Coronary OR Overdose EMS 230

REBEL EM

JUNE 26, 2023

Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03 Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72

FFP 143

FFP Frozen Plasma ALS Plasma 143

Critical Care Scenarios

MARCH 29, 2023

Acute iron overdose can cause anion gap acidosis, GI symptoms including bleeding, and shock and an overal critically ill presentation. Acute iron overdose can cause anion gap acidosis, GI symptoms including bleeding, and shock and an overal critically ill presentation. Buy your merch here! Click here to claim your free CME credit!

Overdose 100

Overdose OR EMS 100

ACEP Now

MAY 8, 2023

Unfortunately, most cases are not so simple, with half of them being unintentional overdoses, many with a delayed presentation; some with delayed-release formulations, combined formulations, or co-ingestions, and some in patients with co-morbidities—all factors that make recognition and management more challenging.

Overdose 52

Overdose ALS OR EMS 52