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Ambulance: Narcan 4mg IN

Written by RSS Poster Medic Scribe » Medic Scribe

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I was a big initial fan of the intranasal atomizers both for pain management and opiate overdoses.  I liked them for pain management for their quick access.  I often gave an intranasal dose, and then after getting an IV, gave the rest IV.  Overtime I noticed quite a difference in response between the two methods.  IN might touch them; IV almost always worked.  Recently I have switched to IM for the quick first dose.  Sure it involves a needle stick, but the onset is quicker and it seems more effective.

I have continued to use intranasal Naloxone as my first line for opiate overdose accompanied, of course, by bag valve ventilation, but I have been having second thoughts about the IN route of late.  I have always preached patience, and when I give Narcan IN, my patience is usually always rewarded with a calm, almost placid patient.  Many of my peers have told me they prefer 1.2 mg IM as their starting dose.  That’s what I used before IN came out.  True, it does return their breathing sooner and almost...

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Ambulance: Hear the Drumming

Written by RSS Poster Medic Scribe » Medic Scribe

Another three dead of heroin overdoses in Hartford in the last 16 hours.  The slaughter continues.  Hartford led the state in overdose deaths in 2015 with 56.  The 2016 numbers, which are not complete, are estimated to be in the high 70s.  Already there have been 5 known heroin deaths in 2016.   I recently did a cardiac arrest of a male in his 40’s just out of rehab, found dead on the couch.  No heroin paraphernalia was seen, but who’s to say the scene wasn’t sanitized before we got there or maybe he snorted outside and walked into the house and collapsed.  Not certain if he ended up as a medical examiner case, but if he did, the evidence will be in the blood, and his name will be added to the tally.

Next week, at our hospital EMS CME, a death investigator from the office of the state Medical Examiner will be speaking to us about heroin and fentanyl.  I am very excited to hear her talk.

I am encouraged that people are the crisis seriously.  From police to health care workers to elected representatives,...

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Ambulance: Neuro EMS

Written by RSS Poster Medic Scribe » Medic Scribe

Check out the great post on Neuro EMS:

30 Seconds to Understanding Drug Addiction

“EMS is at the forefront of emergency medicine therefore we should be at the forefront of shattering mental health stigma and providing compassionate, non-judgemental care.”

Bravo!



Ambulance: Snowbank

Written by RSS Poster Medic Scribe » Medic Scribe

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It is six in the morning and we get called for an overdose outside.  The address is not a surprise — a side street off Park.  Yet when we arrive, we find no one.  We are about to clear when a police officer who has also responded finds a backpack in the snow and sure enough coming down the street is a man who seems somewhat confused.  One side of him is dripping wet as if he had been laying in the snow.  He has come to claim his backpack.  I ask him why half his clothes are soaking wet.  He hesitates a moment, and then says he was helping a friend shovel.  This answer makes no sense.  It is after all six in the morning and the snowstorm was the day before, ending well before sunset.  

We tell him we were called for an overdose, but he knows nothing about it.   I ask him if he has been using drugs in the last several hours.   “Ohhh, nooo,” he says.  “Well, maybe seven years ago, but not for s long time.”

He knows the date and his name and has no interest in going to the hospital.   I suggest we...

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Ambulance: Happy

Written by RSS Poster Medic Scribe » Medic Scribe

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I ask my patients who are addicted to heroin how they got started.  Many tell the same tale.  Injury.  Prescription for Percocet or Oxycontin.  They got addicted.  Prescription either went away or couldn’t keep up with their growing tolerance.  They started buying pills on the street.  Then they learned heroin was cheaper and worked even better and was more widely available.

But not all people become addicted to heroin this way.  Here are three patients’ stories.

Shelly worked in a restaurant.  She was a twenty-eight year old single mom, who was going through a hard time.  Her daughter’s father had left them and she was staying with her mother and stepdad who she felt were always judging her poorly.  She noticed one her coworkers was happy all the time, no matter what was going on in his life.  She asked him how that was.  He said he used heroin.  So she tried it with him one night.  And she had never felt so good.  All her cares when away.  Three years later I am taking her from jail to the hospital for...

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Ambulance: Who Narcan Saves

Written by RSS Poster Medic Scribe » Medic Scribe

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I was at a recent meeting of a statewide opiate overdose working group, composed of a wide variety of community stakeholders all committed to helping curb the crisis, when I heard one woman say the our goal should be Narcan in every medicine cabinet. Certainly Narcan should be in the homes of any person with a history of opiate use.

Narcan saves lives.

But it is important for those who view Narcan as a magic bullet to understand Narcan does not save a life every time it is used.  It is irresponsible for those who know better to issue press releases equating the number of Narcan uses by their organizations with the same number of lives saved.

Narcan does not save patients in true cardiac arrest.

Narcan does not save patients with coma not of opiate etiology.

Narcan does not instantly restore adequate ventilations in those patients who may still be breathing, but who are hypoventilating.  If not given in time, Narcan may not save these people unless someone is there to ventilate them.

Narcan does not save patients...

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Ambulance: Merry Christmas, Hartford

Written by RSS Poster Medic Scribe » Medic Scribe

Merry Christmas, Nathan Hale

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Merry Christmas, Stegosaurus

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Merry Christmas,  Departed

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Merry Christmas, Brotherman

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Merry Christmas, True Hearts

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Fat Turkeys and presents for all!

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Stay safe.



Ambulance: OxyContin Worldwide

Written by RSS Poster Medic Scribe » Medic Scribe

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As the opiate epidemic fueled by the overprescription of Oxycontin and the false claims of its safety is devastating our country, the Los Angeles Times is reporting the drug companies are now aggressively marketing the controversial painkiller overseas, using the same tactics they employed in this country.

OxyContin goes global — “We’re only just getting started”

Read the entire investigative series:

‘YOU WANT A DESCRIPTION OF HELL?’ OXYCONTIN’S 12-HOUR PROBLEM

More than 1 million OxyContin pills ended up in the hands of criminals and addicts. What the drugmaker knew

How black-market OxyContin spurred a town’s descent into crime, addiction and heartbreak

His next pill: An OxyContin user’s journey from pain relief to obsession and addiction

Bravo LA Times for bringing attention to this issue.

For their next investigation, I would like to see them investigate the campaign contributions OxyContin makers have made to current lawmakers.  My guess is they have donated widely and greatly and few have rejected their money.

 



Ambulance: 50,000 Dead-2015 CDC Overdose Report

Written by RSS Poster Medic Scribe » Medic Scribe

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52,404 Americans died of preventable drug overdoses in 2015, an 11% increase over 2015 according to a report released December 16, 2016 by the Centers for Disease Control.

The death rate from synthetic opiates rose a chilling 73%.

Overdose deaths now far outstrip car crash fatalities (37,757) and gun deaths (36,252).

Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015

Connecticut ranked 11th in the Nation for drug overdose death rate, an 11.6 % increase over 2014.

Connecticut had the 2nd highest heroin death rate in the nation (Ohio was number 1. West Virginia 3).

We also saw the 2nd highest increase (125%) in the nation (New York had the highest) in synthetic opiate deaths.

And we already know, the numbers for 2016 will be worse based on data from the first six months of the year.

In Hartford, drug overdoses will kill three times as many people this year as guns.  

What can we in EMS do?

Educate ourselves to the origins of the epidemic and the disease of...

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Ambulance: Hartford Police to Carry Narcan

Written by RSS Poster Medic Scribe » Medic Scribe

 

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When I started as a paramedic in Hartford in 1995, only paramedics carried Naloxone.  Today, BLS ambulances carry it as well as our first responding Hartford Fire Department.  A month from now, our Hartford Police Department officers will also carry it.  This is a good thing.

Hartford Police Begin Carrying Naloxone As Drug Overdose Deaths Continue To Rise

Many times I have shown up at a car accident scene or a report of a man down where the first arriving police officer has shouted to me, “You’re going to need your Narcan!”

Hartford is a drug mecca for our surrounding suburbs, as well as states in northern New England.  Substance users drive in to buy the drug going now on our streets for just $4 a bag or $35 for a bundle of ten bags.  Unable to wait till they get home, they shoot up in their cars and crash or pass out at the wheel in the middle of intersections.  Some who come in on public transit OD at the bus stop or in public restrooms.

The white powder is potent too.  Increasingly,...

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