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Annals of Emergency Medicine - Opioid Overdose and Reversal in Fentanyl Era

Jessica Mason, MD and Patil Armenian, MD
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13:04
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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01:35

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EMRAP 2018 07 July Vol.18 V2 Written Summary 390 KB - PDF

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James H. -

Be careful with this thinking. Article going back to 1994 in Anesth Analg by Glass et all demonstrates increased duration of action Of naloxone With increased dosage amounts. The duration of action is probably not 45 minutes but much longer with these high doses of naloxone. What’s in the manufactures print out is based on a dose of 0.04 mg

Timothy V. -

Can we make a case for just intubating these patients?

If they wake up on naloxone, we are frequently faced with a patient who immediately wants to sign out AMA, with the risk of them going apneic when the naloxone wears off.

If our dosing of naloxone puts them into withdrawal, the ensuing s___storm is a nightmare for all involved.

If we control their airway until the drug has metabolized, when they wake up and want to sign out, we won’t need to worry about relapse.

I am doing this with greater frequency.

Jess Mason -

I think it is best to to avoid intubating patients unless it is really necessary. I would take the risk of them leaving AMA over the risk of an unpredictably difficult intubation and the risks that entails. Also, I think this is one of the arguments for using very low doses of naloxone, just enough to improve respiratory effort.

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EM:RAP 2018 July Full episode audio for MD edition 229:23 min - 319 MB - M4AEM:RAP 2018 July German Edition Deutsche 120:44 min - 166 MB - MP3EM:RAP 2018 July Spanish Edition Español 90:31 min - 124 MB - MP3EM:RAP 2018 July Australian Edition Australian 35:17 min - 48 MB - MP3EM:RAP 2018 July Canadian Edition Canadian 24:10 min - 33 MB - MP3EM:RAP 2018 July French Edition Français 27:05 min - 37 MB - MP3EM:RAP 2018 07 July Individual MP3 Files 293 MB - ZIPEMRAP 2018 07 July Individual Summaries 742 KB - ZIPEMRAP 2018 07 July Spanish Summary 1 MB - PDFEMRAP Board Review Answers 2018 07 July Vol.18 07 116 KB - PDFEMRAP 2018 07 July Vol.18 V2 Written Summary 390 KB - PDFEMRAP Board Review Questions 2018 07 July Vol.18 07 407 KB - PDF

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6 AMA PRA Category 1 Credits™ certified by CEME (EM:RAP)

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