However, we were conservative in our bottom line recognizing there are patients that can be safely discharged home after an opioid overdose and administration of naloxone. We reviewed the Willman et al publication on SGEM#179 and generally agreed with the authors’ conclusions. However, this tool has never been externally validated. The Clinical Decision Rule (CDR) was first derived in Vancouver, BC almost 20 years ago. Validation Rule using O2 Saturation of >95% They concluded: “ For patients treated in the ED for opioid overdose, an observation period of one hour is sufficient if they ambulate as usual, have normal vital signs and a Glasgow Coma Scale of 15”. This teaching has been challenged by a systematic review by Willman et al 2017. Some clinicians have recommended observing opioid overdoses for four to six hours.
It can be administered in multiple ways (intranasal, subcutaneously, intramuscularly, intravenously, nebulization or endotracheal tube). Naloxone is an opioid antagonist that binds competitively to opioid receptors in the central nervous system and gastrointestinal tract. Naloxone is the specific treatment for opioid overdoses and is becoming widely available to first responders of all sorts (Police, Fire, First Aiders, lay people and EMS). Opioids depress the heart rate and breathing, and overdoses can result in death. Wave 3: Significant increase in overdose deaths involving synthetic opioids (like illicitly-manufactured or prescribed fentanyl) beginning in 2013.Wave 2: Rapid increase in overdose deaths involving heroin starting in 2010.Wave 1: Increase in prescription opioid overdose deaths in the 1990’s.Three distinct waves have been observed according to the Center for Disease Control and Prevention (CDC-P):
Two-thirds of the all the drug overdoses in the US in 2016 (63,632) involved an opioid (42,249). Sixty minutes after receiving naloxone he is GCS 15 and walking to the desk demanding to be discharged.īackground: There have been close to 400,000 deaths from an overdose involving any opioid (prescription and illicit opioids) between 19. He is alert and oriented times three with normal vital signs by the time he arrives in the emergency department. They quickly place an IV line and start a fluid bolus of normal saline supplemental oxygen is applied and 1mg of naloxone IV given. The EMS crew observes drug paraphernalia and suspect an intravenous (IV) opioid overdose. Justin Morgenstern is an emergency physician and the creator of the excellent #FOAMed project called Ĭase: A 33-year-old man arrives via emergency medical services (EMS) after initially being found unresponsive with an oxygen saturation of 89%, respiratory rate of six, a systolic blood pressure of 75 mmHg, and pinpoint pupils. Hospital Observation Upon Reversal (HOUR) With Naloxone: A Prospective Clinical Prediction Rule Validation Study.