23 y/o male overdose

[Fleury14]

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]

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

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ODs can still have gag reflexes...

 

[Fleury14]

Never seen an unconscious overdose with one.

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[medichopeful]

And that's the whole point

Just want the OP thinking!

 

[DesertMedic66]

Never seen an unconscious overdose with one.

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

 

[Fleury14]

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]

I was under the assumption we are talking heroin

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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!

 

[DesertMedic66]

I was under the assumption we are talking heroin

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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.

 

[Fleury14]

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]

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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Is that before or after they vomit?

 

[medichopeful]

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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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.

 

[Fleury14]

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]

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.

 

[medichopeful]

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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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.

 

[cprted]

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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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.

 

[Fleury14]

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

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[medichopeful]

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

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