Treatment for Opiate Overdose

[bonedog]

WE use 0.8 mg SC which takes about 7 minutes to raise LOC to the point they can walk to the rig. LEO attend most and convince the patients to accept transport.

I would caution anyone on T&R these patients because as unusual as it may seem some times they lie. Especially be sure to carry the methadone OD.



I had the pleasure of treating an addict for anaphylaxis, once she could breath she accused me of giving her that narcan stuff....^_^

 

[el Murpharino]

Well it's Medic X's turn to lead for pt care... and the treatment option of choice? To give the pt a freakin IO to push 2mg. :glare: Yeah. Enough said. This guy has 10 plus years of "ALS experience" which makes it even the more scary. The ED flipped when they saw what happened. Medic X also got a slap on the wrist for the matter.

Did your agency's CQI have a look at that report and question why this was done? Did it get kicked up to a regional council?

 

[chocchipsmom]

Slamming it all at once can and will send a narc addict into severe withdrawal from it. BAD for them, very bad.

Also, if you can achieve the desired effect with the minimum dosage, you shouldn't have extra stuff circulating.

Cowboy medics give us all a bad name.

One of my former partners was one pf those "Cowboys". I got slammed around the back of the truck til we were able to restrain him.
Our protocols state 0.4 - 2.0 mg titrate to effect. Keep 'em breathing, but don't wake 'em up!

 

[vquintessence]

Did your agency's CQI have a look at that report and question why this was done? Did it get kicked up to a regional council?

Yes and his reasoning was that he couldn't obtain IV access after 2 attempts so IO was acceptable because pt was in imminent respiratory failure. It was behind closed doors and I wasn't his partner that day so I don't know how he explained why IM/SC/IN weren't treatment options (let alone why his partner didn't speak up). MA OEMS doesn't state any specific requirements for an acceptable use of IO, so Medic X technically didn't violate any protocols. The company never reported him to the state. The hospital and pt never spoke up either and it's been well over half a year.

 

[Flight-LP]

I'm surprised that no one has mentioned option "D", just intubate them! Ventilatory support is the issue, if you secure the airway, you then have total control over their respiratory effort. Problem solved without risk of violence, concern for pt. or responder safety, and without concern that your Narcan administration hasn't over stimulated the pts. heart to where the increased myocardial workload and oxygen demand causes them to have an MI.....

I've had a LOT of narcotic OD's over the last decade, not once have I given Narcan. If they are down, keep them down. As long as you can control the airway, you are golden. Let the ER, and a more controlled environment be the one to bring them back down. Doing it in the field is only asking for trouble................................

And I am really dying to know who's great idea it was to teach new Paramedic's to give Narcan after the pt. has been intubated with no sedative or paralyti options. I was seeing that more and more before I left the States, never could understand the f'd up logic to it.....

 

[Melbourne MICA]

Confused

I'm rather confused having read some of these posts. Our protocol in Melbourne is certainly not geared towards partial management of the narcotic overdose. We ventilate and administer the narcotic antagonist to correct the bulk of the side effects of the overdose - IE the neurological narcosis effects and the respiratory depression/suppression.

As I said in my last post, the pt regains consciousness and reacquires spontaneous ventilation's all things being equal. Where poly-pharmacy OD is suspected/confirmed or unknown aetiology is at work we will then manage further and transport to hospital as needed.

On rare occasions a pt will ask to go to hospital or we will suggest this is a good course of action if the pt is not 100% clinically.

Otherwise we fix the problem, inform the pt then discuss options. 99% of the time they refuse transport and are offered some practical advise.

Perhaps our clientele is more predictable and there are less issues revolving around weapons than in the US.

During drug glut periods at my branch alone I could do 2 or 3 heroin OD's in one shift. (I am aware of the other types of Od's of course and we get our fair share of these as well).

Could someone help me out as to why most posters in this thread are talking about deliberately keeping your Pt's unconscious and nearly always transporting.

MM

 

[boingo]

I think intubating them is a bit overkill. Sure, they aren't protecting their airway, but when you have an identifiable and readily treatable etiology of their respiratory depression, we should try to reverse it. There are several systems that treat and release heroin OD's, and some cities even give narcan to their known drug users for self/buddy administration, i.e Boston, San Fransisco. To date there have been no reported bad outcomes, and the majority of those treated by non-EMS personell do not seek further medical attention. I guess if you see heroin OD rarely then intubating may make sense, but as our Aussie friend and others see them daily, intubating them all would be a burden on the system.

 

[bonedog]

In Vancouver I had to, on several occasions treat multiple patients.We would have the FR ventillating while my partner and I would go and innoculate the victims.

I say victims as when ever there was a "corporate take over" the first thing done was release high grade junk to kill off the competitors dealers, along with any of their compadres.

Triage dictated that anyone in cardiac arrest was skipped and move on. I personally treated 8 patient's in one rooming house, while my partner treated 6 more in the alley. There were around 900 deaths that year due to herion OD.

Tubing with these numbers would have been folley, and why would you pack them when you can walk them? My philosophy is lift only when absolutely neccesary.

 

[Melbourne MICA]

Overkill

I think intubating them is a bit overkill. Sure, they aren't protecting their airway, but when you have an identifiable and readily treatable etiology of their respiratory depression, we should try to reverse it. There are several systems that treat and release heroin OD's, and some cities even give narcan to their known drug users for self/buddy administration, i.e Boston, San Fransisco. To date there have been no reported bad outcomes, and the majority of those treated by non-EMS personell do not seek further medical attention. I guess if you see heroin OD rarely then intubating may make sense, but as our Aussie friend and others see them daily, intubating them all would be a burden on the system.

I agree. Without labouring the point, I can't see where there is a pressing need to be overly agressive in Mx of heroin Od's unless they are showing clincial S&S of hypoxic brain injury, credible evidence of poly pharmacy overdose or remain unresponsive to a second Narcan administration. Provided the pt is well ventilated on his/her side with an OP/NP in an IM/IN Narcan dose will do the job every time. Why tie up the ED with streams of readily treatable pts who are just as likey to abscond anyway and certainly don't warrant an ETT probably requiring induction with more side effects to manage for your trouble.

Your situation in the US may be different relative to the "class" of your drug pts and risks therein but here a heroin OD is bread and butter ambo stuff, quick, easy and cost effective with no ED beds tied up and a life saved for your effort.

I'm not trying to tell anybody to suck eggs.

MM

PS I hope all you guys and gals are having a great holiday season.

 

[reaper]

How do you justify leaving them on scene?

Depending on the amount of heroin they have in them, they will need multiple doses of narcan. Yes, you can bring them around on scene, but they may go unresponsive again as soon as the narcan wears off. So do send a unit back out to them again?

 

[Melbourne MICA]

A clash of realities

How do you justify leaving them on scene?

Depending on the amount of heroin they have in them, they will need multiple doses of narcan. Yes, you can bring them around on scene, but they may go unresponsive again as soon as the narcan wears off. So do send a unit back out to them again?

I guess this is where reality and medicine clash. There are always plenty of what if's including heroin OD's and the standard approach is to recommend and offer transport to hospital for all revived and cogniscent (GCS 15) Heroin OD's.

However the ritual reply from my experience and that of others over many years is refusal. Advice is offered for their protection from further drug related harm including the liklihood of further narcosis. But we have no legal grounds to force attendence at hospital.

We've learned from experience and frequent interaction with locals that the compromise position is the best alternative available. As we all know, the potential for violence is always but a missplaced word away.

Clinically from my experiences, the recidivist rate of heroin OD on the same day from the same patient is almost non-existant. At the standard dose we give, 1.6-2.0mg IM there is a low probability of repeat stuporous collapse requiring reattendence.

Ethical/clincial idealism is a mark worth striving for but in such cases reality does bite. We have not had a single attack against officers by opiate OD pt's across the board in years because of this approach. Alternately I cannot remember the last time I went back to the same patient in the same shift. I can only assume the heroin user has survived one more day.

- Now psychostimulants is another matter altogether.

MM

 

[ccfems540]

I am limited by my protocol to give 1mg IV followed by and additional 1mg in 5 minutes if the first dose has no effect. I can also give 2mg IN(1mg per nostril) if no IV access is available.

 

[Ridryder911]

How do you justify leaving them on scene?

Depending on the amount of heroin they have in them, they will need multiple doses of Narcan. Yes, you can bring them around on scene, but they may go unresponsive again as soon as the Narcan wears off. So do send a unit back out to them again?

You can't and hence the troubles. I cannot remember specific to the studies as the main point was attempting to paint a picture wanting more funding to justify "administering Narcan" and or supplying clean needles" for the junkies. In some cities there was also a place to crash and have someone be able to administer Narcan if needed in the first few moments.

From what I recall (after being appalled, that tax monies is being wasted on this b.s.) is most have built a tolerant level, and what usually would kill the "normal" person, barely phases the junkies.

Yup, Liberalism at its finest.

R/r 911

 

[eric2068]

Opiate

I like option c. Option a if absolutely necessary, and option b only if patient is four pointed, suction is ready, and cop armed with a taser. When I was a baby-medic I tried option b. Never make that mistake again.

 

[bonedog]

I see that Switzerland is supplying free heroin and cocaine to addicts to cut out the organized crime.

Great idea as obviously the "war on drugs" is an abysmal failure.

Now they will only have to concentrate on easier crimes like prostitution and gambling, although with free dope the hookers won't have to turn tricks to support thier habits, win win....

 

[knxemt1983]

depends on if I like the er staff we're going to see. if I like em 0.4 titrated, if not then I titrate it until we hit the ed hall then give it all to em and let the ed deal with it....


no seriously, I'm kidding, I have seen it done like that but I don't, titrate to effect to reverse resp depression. The ones I have had thats basically what the edoc has done too brought them out slowly.

 

[Sasha]

I see that Switzerland is supplying free heroin and cocaine to addicts to cut out the organized crime.

Great idea as obviously the "war on drugs" is an abysmal failure.

Now they will only have to concentrate on easier crimes like prostitution and gambling, although with free dope the hookers won't have to turn tricks to support thier habits, win win....

And when they OD and die, their family can sue the government.

 

[JPINFV]

Now they will only have to concentrate on easier crimes like prostitution and gambling, although with free dope the hookers won't have to turn tricks to support thier habits, win win....

You mean not everyone works for hookers and blow?
/sarcasm (MAJOR SARCASM)

 

[bonedog]

One end of the scale or the other, just throw em' in jail with that Tommy Chong....

 

[eric2068]

Don't ya love it. Ya ask the question "Do they use drugs?" You get the shocked response, "No, never!!!" Then the narcan works.
Life is tough, it's tougher when you are stupid.-John Wayne :wacko: