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Ambulance: THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE, AND ADDICTION

Written by RSS Poster Medic Scribe » Medic Scribe

 

brain

I used to believe that addiction was a character flaw, and that the drug fiends I treated on the streets of Hartford were there due to their own poor choices.  That doesn’t mean I treated them badly. I have always tried to treat all my patients as if I were treating members of my own family.  That said, like anyone I have good days and bad days, and don’t always live up to my expectations.

The older I get the less judgmental I am.  I guess I have seen people go through hard times over the years, and am more sympathetic.  I view the drug fiends, as I called them, differently now for two reasons.

One, I know people can stumble, they can make mistakes and they can have bad luck.  Not all roads traveled lead to good ends.

Two, science now makes a compelling case that addiction is a brain disease.  Hard core addicts are crippled in their thinking in much the same way that people with heart disease have diminished cardiac capacity or diabetics have problems...

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Ambulance: A Life Saved

Written by RSS Poster Medic Scribe » Medic Scribe

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A 24 year old man from one of Hartford’s suburbs had his life saved by a newspaper.

He got into heroin five years ago through, in his own words “stupidity.”  While many get into it through injury, a doctor’s prescription exposing them to opiates, taking too many, becoming addicted, getting cut off or needing more than the doctor will give, having to buy pills on the street, then transitioning to the cheaper heroin, he got into the deadly opiate through partying.  Hell, try Heroin, why not?  Rock on, Dude!

He comes down to Hartford and buys on the street.  A two bundle (20 bags) a day habit.  He doesn’t inject, he sniffs.  He just walks down Park Street and the dealers know what he’s looking for.  Pale white guy with tattoos,  wearing a hoodie.  We know you’re not here to sample the empanadas at Aqui Me Quedo.  KD? KO? Fasttrack? Night Owl?  High Power?  We got what you’re looking for.

He got caught up in a drug sweep once, but hadn’t bought his drugs yet, so after being frisked, they let...

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Ambulance: Facing Addiction in America

Written by RSS Poster Medic Scribe » Medic Scribe

facing addiction

On November 17, 2016, the Surgeon General of the United States issued a report, Facing Addiction in America.  The 400 plus page report is a fascinating read that draws on the latest research and data to describe the current opioid crisis, the science behind addiction and the best prospects for treatment and prevention.

Landmark report by Surgeon General calls drug crisis ‘a moral test for America’

Consider these facts:

Seventy-eight people die of an opiod overdose each day in our country.

Only 20% of people who need opiod use treatment are getting treatment.

The estimated cost to the country of opiod drug abuse is $193 billion a year.

Heroin overdoses tripled between 2010 to 2014. Heroin overdoses are 500% higher than they were in 2014. overdoses were more than five times higher in 2014 (10,574) then ten years before in 2004 (1,878).

“How we respond to this crisis is a moral test for America. Are we a nation willing to take on an epidemic that is causing great human suffering and economic loss?...

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Ambulance: Bart Simpson Does Heroin

Written by RSS Poster Medic Scribe » Medic Scribe

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Bart Simpson is in his parent’s Subaru parked to the side of a gas station in Hartford, Ct near the highway ramps.  The car is running, in drive, his foot is on the brake.  He is slumped forward against the wheel.  This has aroused the attention of passerbys who have called 911.  An ambulance arrives within minutes.  The paramedic and EMT get out and try to open the doors which are locked.  The EMT bangs hard against the window, while the paramedic, who has gone to the passenger side, bangs on that window.  He also notices through the tinted windows a second person in the passenger seat, also slumped over.  The banging causes Bart to stir.  He opens his eyes, and appears frightened.  He moves his hand to the drive control, but then realizes he is already in drive.  He tries to go forward, but a bus is blocking the intersection and now a police officer is also there yelling and banging against the car. “Stop the car!  Stop the car!”

Bart puts the car in park, and freezes a moment.  The...

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Ambulance: The Opiate Refusal

Written by RSS Poster Medic Scribe » Medic Scribe

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The Opiate Refusal

Called for ETOH.  On arrival found 28 year old male slumped on park bench, GCS-3, respiratory rate -4, cyanotic around lips.  Does not respond to stimulation.  Given 2 mg Narcan IN by FD just prior to our arrival, ventilated with ambu-bag using two person method.  Initial ETCO2-94.  Sinus at 88.  BP 130/70.  No signs of trauma.  Pupils pinpoint.  Heroin bag “New arrival” observed in grass near bench.  ETC02, came down to 45 within 2 minutes, respiratory rate increased to 14.  Patient opened eyes shortly after on stimulation.  Sits up on own.  Denies heroin use or opiate use.  Denies any medical problems.  Tells us to “F-off.”  Leaves AMA despite attempts to advise patient of risks of refusing up to and including death.  Seen walking away  with and cussing out woman who FD said had flagged them down when they arrived at park.

The Insulin Refusal

Called for unconscious.  On arrival found 43 year old male slumped over on bench at bus stop, skin cool, clammy.  GCS-3. ...

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Ambulance: EMS Fights Opiate Epidemic

Written by RSS Poster Medic Scribe » Medic Scribe

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Fighting opiate addiction is every bit as important as fighting the other diseases we encounter — STEMI, stroke, trauma, sepsis and the like.

There is a tremendous article on the  JEMS website by Dr. Alex Garza and Dr. Sophia Dyer about EMS joining the fight against the opiate epidemic in a broader way than just responding to overdoses and administering Narcan.

EMS Data Can Help Stop the Opioid Epidemic

Read it, and then consider what is happening in your EMS system.

In ours, we are treating increasing numbers of patients addicted to opiates, some who get Narcan, some who don’t, some who go to the hospital, some who refuse at the scene.  We see them all, but not all of them get into the system to get help.  Like those scene refusals, many of those who go to the hospital, leave AMA before they get a chance to get counseling.  While not all of them will desire or enter counseling, the health care system should at least be there near to the time of overdose offering help.

The fight against opiate...

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Ambulance: Murals of Hartford

Written by RSS Poster Medic Scribe » Medic Scribe

I have been writing much lately about sorrow and despair in Hartford, so I thought I would take a break, and lifting my eyes up from the heroin bags on the ground, look at some of the beauty of Hartford as seen on the city’s murals.

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Ambulance: Election Day

Written by RSS Poster Medic Scribe » Medic Scribe

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A 10-year-old girl was shot in the face in Hartford yesterday. She wasn’t walking down the street or riding a school bus, she was in her own home when the bullets raked through the front door. She doesn’t live on a busy street like Park Street or Albany Avenue where criminal activity can be going on at all hours of the day. She was on a quiet residential street with sidewalks and front lawns and single family homes. Clearly she was not the intended target of the bullets, just collateral damage. This isn’t the first time a child has been struck by a bullet in this country much less the first time in Hartford. Kids getting shot is pretty commonplace in urban American. Still I thought for certain it would be a big story of the national news. I envisioned the presidential candidates talking about it in their final speeches before the country. Sadly it is hard to find more than a brief mention of it a day later. An AP wire story, two minutes on the local news the night it happened, and it is already on its...

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Ambulance: Bad Batch?

Written by RSS Poster Medic Scribe » Medic Scribe

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Hartford Cops: Rash of Heroin Overdoses Part of Upward Trend

 After a lull of a few weeks, the overdoses started going out again this week.  An hour after I left work Tuesday night, there was a triple OD that is widely being reported in the news, along with two other overdoses not long after.  The papers haven’t reported it, but I know of an additional overdose earlier in the day, who required two mgs of Narcan intranasal to resuscitate as well as a presumption the next day that the medics believed to be heroin related — a young person with a heroin history found cold and stiff alone at home with no apparent trauma.  That person once toxicology reports are in may well be be added to the list of heroin deaths in the state that is estimated to reach almost 900 this year.

The police are working overtime to determine if this is due to a new bad batch of heroin (perhaps with Fentanyl) or just an anomaly.  My money is on a bad batch.  The police released pictures of the two brands found at the scene.  One skull and...

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Ambulance: Atomizer Recall May Hurt Overdose Efforts

Written by RSS Poster Medic Scribe » Medic Scribe

New Picture

The Connecticut Department of Public Health has alerted all EMS services in the state that there is recall on the MAD Nasal Intranasal Mucosal Atomizer Device.  The company recall notice says” Teleflex Medicine is recalling these products as they may not deliver a fully atomized plume of medication. ”  The company says they have received complaints that the “affected product lots produced a straight stream instead of an atomized spray.”  They go on and say “the failure of the device to deliver an atomized plume may impair the effectiveness of situations, such as where the device is used in an off-label manner for needle-free delivery of drugs for reversal of life threatening narcotic overdose…”

This will not affect paramedics who still have the IM and IV methods of administration, but it may hamper first responders, who will have to wait for new shipments of corrected atomizers.  In the meantime, all responders should make certain that patients are being properly bagged.

I am more...

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