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SGEM#453: I Can’t Go For That – No, No Narcan for Out-of-Hospital Cardiac Arrests

The Skeptics' Guide to EM

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. Your partner asks if you want to administer naloxone as well. Today’s study looks at the role of naloxone in OHCA. Naloxone is a well-established medication used primarily for reversing opioid overdoses. JAMA Network Open.

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The daily educational pearl – naloxone dosing

EMergucate

You suspect that your patient has opioid toxicity and you decide to administer naloxone. But how much? – known opioid … Continue reading →

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Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

Alternatively, one can cut the 2 mg Suboxone (buprenorphine + naloxone combination) strips into 4 pieces after waiting for a longer washout period (72-96 hours of abstinence from non-medical opioids) before starting the induction. Or one can start methadone induction. Journal of general internal medicine. 2017 Jun;32:660-6.

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Protocol Change

Peter Canning

Naloxone was given for coma of unknown etiology; sodium bicarb for cardiac arrests of unknown downtime. We carried Cardizem for rapid a-fib, fentanyl for pain, intranasal naloxone, and Haldol and midazolam for violent emotionally disturbed patients. People in pulmonary edema got Lasix. Six PVCs in a minute and you got lidocaine.

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SAEM Clinical Images Series: Xylazine Wounds

ALiEM

Necrotizing fasciitis Case Question: Will naloxone reverse a xylazine overdose? Laboratory Data CBC : Hgb 2.74 (compared to baseline of 9.0); WBC count 17.39 BMP : Na 126; K+ 5.9; up from 0.69) ESR : >100 CRP : 15.94 However, fentanyl is the most common drug combined with xylazine.

NARCAN 141
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No, I Say

Peter Canning

“We need a lot more naloxone than ever before. The research I have based on over 20,000 EMS run forms shows naloxone has remained effective over the years. Naloxone works against opioids if it is given in time. When someone gets 20 milligrams, I ask what form was the naloxone in and how long was there in between doses?

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Ep 116 Emergency Management of Opioid Misuse, Overdose and Withdrawal

Emergency Medicine Cases

In this episode Dr. Kathryn Dong, Dr. Michelle Klaiman and Dr. Aaron Orkin discuss the latest in naloxone in opioid overdose cardiac arrest and altered LOA, a 5-step approach to ED opioid withdrawal management and how we can improve mortality and morbidity in patients with opioid use disorder in the era of the opioid epidemic.

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