# 23 y/o male overdose



## Exp. Hatam (Jul 9, 2016)

You respond to the scene of a 23 year old male who has overdosed in his house. He is lying on the couch with respiration of 4 BPM. You and your partner lift him onto the floor. Next, would you:

A) Provide 95% O2 via Nonrebreather  mask

B) Provide 6 LPM O2 via nasal cannula

C) Provide 100% O2 via BVM

D) None of the Above


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## Carlos Danger (Jul 9, 2016)

A.

Plus 200 mcg of nalaxone. Then switch the NRB for a NC or room air once Sp02 gets above 90%

What did I win?

P.S. If this was a homework question, tell your instructor he doesn't know what he's doing.


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## Exp. Hatam (Jul 9, 2016)

Why wouldn't the BVM be used?


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## DesertMedic66 (Jul 9, 2016)

Exp. Hatam said:


> Why wouldn't the BVM be used?


You tell us


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## Exp. Hatam (Jul 9, 2016)

The BVM is used for a non-breathing patient.

My book says that the BVMs could also be used to ventilate patients with inadequate respirations (e.g. drug overdose).


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## DesertMedic66 (Jul 9, 2016)

So then what would you do for this patient?


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## NomadicMedic (Jul 9, 2016)

Sounds like a basic question (i.e.: no Narcan) so it would be C with an ALS intercept for Narcan.


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## medichopeful (Jul 9, 2016)

Remi said:


> A.
> 
> Plus 200 mcg of nalaxone. Then switch the NRB for a NC or room air once Sp02 gets above 90%
> 
> ...



NRB with a respiratory rate of 4?  Also, nothing necessarily says this is an opiate overdose.  Likely? Depends. But could be benzos, multisubstance,etc.


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## gotbeerz001 (Jul 9, 2016)

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## cprted (Jul 9, 2016)

Patient found down, shouldn't assume this is an overdose at all.  Lots of other differentials to consider ...


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## Fleury14 (Jul 9, 2016)

OPA, assist ventilations with a bvm for 2 minutes, narcan, continue assisting w/bvm until he wakes up... Simple BLS call. 

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## medichopeful (Jul 9, 2016)

Fleury14 said:


> OPA, assist ventilations with a bvm for 2 minutes, narcan, continue assisting w/bvm until he wakes up... Simple BLS call.
> 
> Sent from my Nexus 6P using Tapatalk



I would be careful with an OPA. NPA maybe, but I would be concerned about vomiting.


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## Carlos Danger (Jul 9, 2016)

medichopeful said:


> NRB with a respiratory rate of 4?  Also, nothing necessarily says this is an opiate overdose.  Likely? Depends. But could be benzos, multisubstance,etc.


The OP said it was an OD.

What besides opioids causes a RR of 4?


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## Fleury14 (Jul 9, 2016)

medichopeful said:


> I would be careful with an OPA. NPA maybe, but I would be concerned about vomiting.


Always OPA first in that situation. 

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## medichopeful (Jul 9, 2016)

Remi said:


> The OP said it was an OD.
> 
> What besides opioids causes a RR of 4?



Benzos and alcohol can both cause respiratory depression. I'll give it to you it's most likely an opiate, but other substances can cause respiratory depression or arrest.


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## medichopeful (Jul 9, 2016)

Fleury14 said:


> Always OPA first in that situation.
> 
> Sent from my Nexus 6P using Tapatalk



What's your thinking on that? I'm legitimately curious.


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## DesertMedic66 (Jul 9, 2016)

Fleury14 said:


> Always OPA first in that situation.
> 
> Sent from my Nexus 6P using Tapatalk


Why always?


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## Fleury14 (Jul 9, 2016)

Ok maybe with some kind of oral trauma but otherwise why wouldn't you try to use the opa first? 

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## DesertMedic66 (Jul 9, 2016)

Fleury14 said:


> Ok maybe with some kind of oral trauma but otherwise why wouldn't you try to use the opa first?
> 
> Sent from my Nexus 6P using Tapatalk


If you're an ALS unit Narcan. There is still a decent possibly of an intact gag reflex


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## Carlos Danger (Jul 9, 2016)

medichopeful said:


> Benzos and alcohol can both cause respiratory depression. *I'll give it to you it's most likely an opiate,* but other substances can cause respiratory depression or arrest.



And that's the whole point


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## Fleury14 (Jul 9, 2016)

And if they have one then it isn't an od 1. That's what the original post is correct?

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## DesertMedic66 (Jul 9, 2016)

Fleury14 said:


> And if they have one then it isn't an od 1. That's what the original post is correct?
> 
> Sent from my Nexus 6P using Tapatalk


ODs can still have gag reflexes...


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## Fleury14 (Jul 9, 2016)

Never seen an unconscious overdose with one. 

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## medichopeful (Jul 9, 2016)

Remi said:


> And that's the whole point



Just want the OP thinking!


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## DesertMedic66 (Jul 9, 2016)

Fleury14 said:


> Never seen an unconscious overdose with one.
> 
> Sent from my Nexus 6P using Tapatalk


Had one this morning. OD on Vicodin and sleeping pills with intact gag.


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## Fleury14 (Jul 9, 2016)

DesertMedic66 said:


> Had one this morning. OD on Vicodin and sleeping pills with intact gag.


I was under the assumption we are talking heroin 

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## medichopeful (Jul 9, 2016)

Fleury14 said:


> I was under the assumption we are talking heroin
> 
> Sent from my Nexus 6P using Tapatalk



Be careful about jumping to conclusions. An overdose with a decreased RR doesn't necessarily equal an opiate overdose (heroin included obviously).  

That being said, you can definitely have a gag-reflex with many overdoses, heroin included.

Let's say that (theoretically) the patient didn't have a gag-reflex, so you put in an OPA.  You reverse the OD, and they wake up.  With an OPA in their mouth, what's one of the first things they may start doing?  Just trying to get you to think!


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## DesertMedic66 (Jul 9, 2016)

Fleury14 said:


> I was under the assumption we are talking heroin
> 
> Sent from my Nexus 6P using Tapatalk


What kind of drug is heroin?

I was simply referring to my most recent call with an OD that included an opioid. I've had maybe a handful of heroin ODs (heroin isn't big in my area) and the majority of them have still had a gag reflex. Saying "always do this" is not the best way to treat patients.


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## Fleury14 (Jul 9, 2016)

The first thing I always do when someone starts waking up is tell them to pull the opa out of their mouth. 

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## DesertMedic66 (Jul 9, 2016)

Fleury14 said:


> The first thing I always do when someone starts waking up is tell them to pull the opa out of their mouth.
> 
> Sent from my Nexus 6P using Tapatalk


Is that before or after they vomit?


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## medichopeful (Jul 9, 2016)

Fleury14 said:


> The first thing I always do when someone starts waking up is tell them to pull the opa out of their mouth.
> 
> Sent from my Nexus 6P using Tapatalk



There's a very good possibility that someone will start gagging and vomiting before they start to follow commands. 

Just avoid the whole issue and place an OPA, if an airway is even needed.


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## Fleury14 (Jul 9, 2016)

I've never seen a legit opiate od where they started gagging. I have however seen a fake one sit right up on the opa attempt. 

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## StCEMT (Jul 9, 2016)

If they are going to wake up, why even use the OPA? You can manually position the airway and bag til the Narcan kicks in.


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## medichopeful (Jul 9, 2016)

Fleury14 said:


> I've never seen a legit opiate od where they started gagging. I have however seen a fake one sit right up on the opa attempt.
> 
> Sent from my Nexus 6P using Tapatalk



I've never seen a lot of things.  Doesn't mean it doesn't happen.

Even if it doesn't happen when they're unconscious, we need to be thinking about what comes after an intervention.  Waking up, gagging, then vomiting is a good way to aspirate.


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## cprted (Jul 9, 2016)

Fleury14 said:


> I've never seen a legit opiate od where they started gagging. I have however seen a fake one sit right up on the opa attempt.
> 
> Sent from my Nexus 6P using Tapatalk


Was it fake, or was the stimulus of the OPA being inserted enough to bring them around?  I've never had anyone fake an OD, but I have had a couple that were hypoventilating, sonorous resps, and unresponsive to a trap squeeze sit right up upon insertion of an OPA.


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## Fleury14 (Jul 9, 2016)

Fake was obviously a poor choice of words. It was enough to wake them out of the nod. 

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## medichopeful (Jul 9, 2016)

Fleury14 said:


> Fake was obviously a poor choice of words. It was enough to wake them out of the nod.
> 
> Sent from my Nexus 6P using Tapatalk



If it's enough to wake them up, there's a good possibility it's enough to make them gag.


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