[quetza]

drug addiction is harrowing. I've had the unfortunate opportunity to see it wreck many lives.

though i'll never forget the well-known IV drug abuser, who would frequently visit the ER i worked at, who came in one night with a bad abscess in one of his injection sites. As i prepared to numb up the area so I could cut it open and drain it he totally flipped out at the site of the needle.

I said, "don't you inject drugs on a daily basis?!"
He responded, "hey fuck you man!!"

both our comments were in jest and it was a memory that i'll never forget from that hell-hole of an ER. we both had a good laugh

[Entropy]

If you come across a narcotic OD who is unconscious and barely breathing then you must oxygenate and ventilate before simply whacking them with naloxone or there is significant risk of seizures due to the hypoxia and acidosis. Simple EAR (mouth-do-mouth) will do if you are comfortable and confident; mouth guards are widely available.

Even if the patient is not significantly hypoxic, administration of naloxone risks unmasking other drug effects in the setting of polypharm overdose. What this means is that if they have had narcotics to come down from stimulants, then blocking the depressant activity of opiates may result in the patient suddenly demonstrating stimulant overdose... only exacerbated by hypoxia from opioid-induced hypoventilation.

Call for help. Ventilate the patient if you can, however you can. If you have access to a bag valve mask and oxygen then this may be all they need. We do our best to ventilate and oxygenate and transport without reversing the OD, so that the patient wakes up slowly and safely in hospital and is thereby counselled and offered treatments. We only use naloxone if they are so obtunded that airway management and ventilation are an issue.

TL;DR: Reversing the overdose pharmacologically does not fix the actually problem that causes death, which is hypoxia due to not breathing deeply and frequently enough. We must manually ventilate and oxygenate as giving naloxone without doing this first creates risk of seizures and subsequent brain injury. It's great that bystanders are keen to help, but please focus on the basics - airway and ventilation - before simply reaching for a magic needle.

[b1gpoppa]

Originally Posted by Entropy ↗

If you come across a narcotic OD who is unconscious and barely breathing then you must oxygenate and ventilate before simply whacking them with naloxone or there is significant risk of seizures due to the hypoxia and acidosis. Simple EAR (mouth-do-mouth) will do if you are comfortable and confident; mouth guards are widely available.

Even if the patient is not significantly hypoxic, administration of naloxone risks unmasking other drug effects in the setting of polypharm overdose. What this means is that if they have had narcotics to come down from stimulants, then blocking the depressant activity of opiates may result in the patient suddenly demonstrating stimulant overdose... only exacerbated by hypoxia from opioid-induced hypoventilation.

Call for help. Ventilate the patient if you can, however you can. If you have access to a bag valve mask and oxygen then this may be all they need. We do our best to ventilate and oxygenate and transport without reversing the OD, so that the patient wakes up slowly and safely in hospital and is thereby counselled and offered treatments. We only use naloxone if they are so obtunded that airway management and ventilation are an issue.

TL;DR: Reversing the overdose pharmacologically does not fix the actually problem that causes death, which is hypoxia due to not breathing deeply and frequently enough. We must manually ventilate and oxygenate as giving naloxone without doing this first creates risk of seizures and subsequent brain injury. It's great that bystanders are keen to help, but please focus on the basics - airway and ventilation - before simply reaching for a magic needle.

A great and simplified summary Entropy, thanks for putting it up here. I always say to my sons and their friends - if you every call an EMT (and especially if you come into my ER) the reason we ask you "WHAT HAS YOUR FRIEND TAKEN ????" is because in such a polypharm era, there may be a series of things we need to do first before Narcan - and if we don't know, then it could cost a friend a life. This isn't Pulp Fiction, we don't just jack you up with a harpoon through the sternum - I tell them it doesn't matter what a friend has taken (we all know young adults are going to experiment), just tell the ER or EMT everything you know ...... they are not there to turn you into the PD, they are there to save your life or your friends life ....... never just dump them in the foyer and run, be a man and stay there and provide information to help your friends - and get the point across that they should do the same for you.