You're just making things hard on yourself by doing it pre-hospital, it's not going to change your management otherwise or the patient's disposition if you give it, and even though it's rare, if you do get those complications the job is going to turn to shit. Slug em with hypertonic bicarbonate or hypertonic saline, oxygenate, and ventilate. But that's it on top of a looot of other things. Mostly because I’ve gone through all my meds and I’m trying for a Hail Mary before I call it. }); Dettmer K1, Saunders B, Strang J. return jQuery("#cit21099064 .abstr").text(); Time and weather: 1045, clear and sunny . This video is a small snapshot into the life of a student paramedic when on placement. I have never heard of it reversing VF rhythms. Opiate overdose persists as a major public health problem, contributing to significant morbidity and mortality among opiate users globally. Clinical scenario: A patient found unresponsive by the road You are dispatched to a report of a male found down on the sidewalk in a suburban neighborhood Squad 24, ALS Medic 3, respond Priority 1. You use standard ACLS protocols for cardiac arrest. Number of … An iGel is in situ, with good chest rise and no vomit. Naloxone 800mcg IM. Other side effects reported included vomiting, chest infections, seizures, pulmonary oedema and palsy. Depending on what the heroin was made with, you are looking at potential negative inotropy if it was anything metabolized into morphine This is on the hope it would help increase coronary perfusion pressures. 2002 Aug;97(8):963-7. Call type: Dispatched to 1313 Mockingbird Lane for diabetic problems Time and weather: 0630 cool and sunny . The myth of full-thickness burns not having pain is just that – many of these patients will not complain of sharp pains, but many complain of deep aching pains related to the inflammatory process. Call type: Dispatched to the local baseball fields for a male complaining of shortness of breath . return jQuery("#cit12144598 .abstr").text(); Interactive EMT Scenarios. 12 lead ECG acquired. You’ve now got a patient who cannot be given Opiate-Benzo sedation and instead likely requires Ketamine. Mixed thickness (partial and full thickness) burns to extensor surface of left arm from shoulder to elbow; left lateral thoracic wall; left lateral abdominal wall; lateral aspect of left flank and left buttock. They really did a great job with this patient. }, 4950 W Royal Ln Irving, TX 75063. membership@acep.org 800-798-1822 Copy link. Despite the obvious effect fo the heroin and the accepted Mx of naloxone- I wonder if in some ways it’s facilitates airway management/analgesia until at ED and then let them sort it. BMJ. BLS Opioid Overdose (Scenario 10) BLS scenario 10 is the final BLS scenario within the BLS Express Study Guide. Some EMS calls, like a non-complicated fracture of the forearm, can be relatively straightforward. Not the worst drug, but if they’re Hypertensive already... well. [4/8/13] 322 Stowecroft — unknown medical. They are based on the Alaska Skill Sheets and the 1994 Revision of the United States Department of Transportation EMT-Basic curriculum. As per Warner-Smith et al. Video created by University of Colorado System for the course "Prepare for the EMT Certification Test". ‎EMT Scenarios is now EMT tutor lite, with a practice quiz and flashcards. I mean, I probably wouldn’t give it Intra-arrest unless I was losing Vfib voltage. By KAREN OWENS Scenario: Your medic has been asked to respond to a residence in your first-due area known for high drug use and frequent overdose calls. I agree with most of what you said. A quick discussion about the myth that people can suffer a fentanyl overdose through simple skin contact with the drug and practical safety tips for EMTs. Once there's good airway compliance and the numbers look good transport with the iGel, no real point chucking out a good airway. Let’s break it down. PMID: 21099064. Benzos for breakthrough agitation that the precedex won’t take care of, and cooling as needed. Bolger, A. You sound like you've done this before. Take home naloxone and the prevention of deaths from opiate overdose: two pilot schemes. Impression: Patient lying in bed EMTutor presents over 50 scenarios written for the EMT based on real life situations. [5/13/13] 21 Chapman St — unknown. A 28-year-old man was found unresponsive at home by a roommate. Emergency Scenarios with Case Review Seizure This emergency scenario is about a patient with seizure, and is set up for role-play and case review with your staff. Our scenarios are interactive and are written by experienced EMTs & Paramedics. Tap to unmute. If it was primarily made with fentanyl, that’s essentially cardioneutral and then we wouldn’t have any effect Intra-arrest, and given a useless (with a small but not insignificant chance of side effects). Case Scenario, Overdose Arrest. C.R.A.S.H.E.D – A model for structured reflection in prehospital care. He was unresponsive to intranasal naloxone (2 mg) that was administered via mucosal atomizer twice. You can only overdose if you intentionally inject it or intentionally snort it into your nose. Study Center > Student Quizzes > Narcotic Overdose. […] This is the first in our case study series. You're the second crew on scene, backing up a car with a paramedic and a student. I’ll throw it at a PEA or Asystole when I think there’s a possibility they had a respiratory arrest due to opioids. CXR and bloods acquired. Programs that distribute naloxone to opiate users and their acquaintances have been successfully implemented in a number of cities around the world and have shown that non-medical personnel are able to administer naloxone to reverse opiate overdoses and save lives (Bazazi et al., 2010). We’re looking for paramedics, student paramedics, EMTs and others worldwide to submit case studies in a similar format. Gen. If you were to give narcan to a patient in cardiac arrest with heroin in their system, what is the theory there? At least for the partial thickness burns, and areas surrounding full thickness ones. There is opioids in the system, causing respiratory depression and hypoxia leading to cardiac arrest. is not an indication to give a drug. Take home naloxone and the prevention of deaths from opiate overdose: two pilot schemes. So they now have a respiratory drive, but they are still in VF? MANAGEMENT. SCENE SIZE-UP Scene safety: Safe . Family doctor called for. O2 @15lpm commenced. If you've got a patent airway and good ventilation, you're already sorting out said respiratory depression by doing it yourself. Initially no, but there is a very small indication that I think is worthwhile, which is in the short term arrest, post ROSC patient who has poor cardiac output and I want to promote negative pressure ventilation. Also a practice test, and practice flashcards. Lisbon: EMCDDA, EMCDDA (2002) 2002 Annual Report of the State of the Drugs Problem in the European Union and Norway. Narcan isn't going to do anything helpful for me that I won't already be doing. Simulation Scenarios This material is made available as part of the professional education programs of the American Academy of Pediatrics and the American College of Emergency Physicians. Seen commonly in epileptics but can be elicited by stress, overdose of local anesthetic or intravascular injection of local anesthetic. Terms of Use, Advertising & Privacy Policy. The following two tabs change content below. Submit your own case study here! Recognize Overdose •If a person is not breathing or is struggling to breath: call out name and rub knuckles of a closed fist over the sternum (Sternum Rub) •Signs of drug use? [3/25/13] Minuteman Bikeway — assault. The study concludes by recommending training for drug users on overdose treatment, supervised drug injecting facilities and pilot Naloxone distribution programmes for drug users. This site complies with the HONcode standard for trustworthy health information: verify here. I fix the respiratory problem with a ETT or supraglottic airway and ventilate my patient. Use the EMTutor Lite to see where you stand with recent updates with EMT Basic material.… MSc thesis submitted to Dublin City University. 2001 Apr 14;322(7291):895-6. Direct factors including peripheral neuropathy (49%) and limb paralysis (26%) were reported by users due to extended periods of lying on limbs during unconsciousness due to overdose. Required BSI: Standard Precautions . These will provide for foundation reading on conditions and presentations, will contain links to articles of interest and may be of use to anyone doing university assignments or further research on a particular area. (2002) there is extensive morbidity both direct and indirect, associated with non-fatal heroin overdoses. –Pills, drugs, needles, cookers •Look for overdose –Slow or absent breathing •Gasping for breath or a snoring sound –Pinpoint pupils –Blue/gray lips and nails Copyright © 2014 Prehospital Research Support Site. You give naloxone to reverse respiratory depression from an opioid overdose. There are an estimated 14,452 heroin users in Ireland (Kelly et al, 2003). PRIMARY ASSESSMENT. A 20 year old male, presents to ambulance crew through emergency call with altered level of consciousness, respiratory depression, extensive burns to left torso and flank secondary to IV heroin overdose. This scenario covers BLS for opioid overdose. any product or service should be inferred or is … Submissions can be credited or anonymous based on your wishes. Patient is in recovery position upon arrival of crew. Have you become an expert at assessing narcotics overdose and administering naloxone? jQuery(document).ready(function() { Upon arrival on the scene, EMS staff should check for critical signs of an opioid overdose and try to determine which drugs the individual took. Morbidity associated with non-fatal heroin overdose. MOA for naloxone is it’s a competitive antagonist for opioid receptors. Narcan In-arrest, and your patient gets ROSC and no longer tolerates an airway and requires RSI. 2010 Nov;21(4):1108-13. Both Option 3&4. It reverses respiratory depression, sedation and hypotension through this competitive antagonism. showURL: false Address circulation and ventilation before administering naloxone. Opiate overdose can be reversed by the timely administration of naloxone. What of the implications for RSI meds / analgesia selection if the rosc results in a lowish GCS with airway difficulties? J Health Care Poor Underserved. /r/EMS is a subreddit for medical first responders to hangout and discuss anything related to emergency medical services. Part 1 and 2 will prepare you for the BLS scenarios and help you achieve mastery of BLS concepts before beginning the scenarios. Info. This view is re-iterated by Dettmer et al (2001), who study two successful Naloxone distribution schemes, one in Berlin and one in Jersey. An advanced paramedic is enroute. 2) Cut up the “role” pages, and assign several roles, distributing the “roles” to … No endorsement of . Wounds reviewed by Plastic Surgery, for debriding in theatre the following day. 1. All it does is restore spontaneous breathing in an opiate overdose--if the heart has stopped, the spontaneous breathing ship has sailed, and you don't want it to come back until they're nice and stable post ROSC, presumably many hours later in the ICU. In relation to this case study, 24% of heroin users interviewed had received burns due to an overdose, similar to the patient discussed above. The study interviewed 10 heroin users who had personally experienced an overdose within the last 12 months, and all had witnessed another person overdosing. opioid overdose, whereas student learners may only need to manage the opioid overdose. ] If you have not completed part 1 and Part 2 of the BLS Express, make sure to do that. A 20 year old male, presents to ambulance crew through emergency call with altered level of consciousness, respiratory depression, extensive burns to left torso and flank secondary to IV heroin overdose. You are just getting settled into bed at the station, after a long day of running calls. 911: You are called to the residence of a 68 year old female complaining of respiratory distress. • Coworker. Good CPR in progress, not tired. You're a double paramedic crew, called to a 28 YOM in cardiac arrest, secondary to cocaine and heroin toxicity. ), CXR – to identify pneumonia, pneumothorax, pleural effusion etc. (EMCDDA, 1997). Post arrest, if I’m dealing with Cardiac stunning they get the narcan. Abuse and overdoses associated with prescription and illicit opioids have been characterized by the U.S. Department of Health and Human Services as a national crisis.1 Since 2000, the rate of overdose deaths involving opioids has increased four-fold.2,3 Drug overdose deaths are now the leading cause of injury death in the United States.4 Overdoses due to opioids occur as a result of their central nervous system effects, which cause respiratory depression that can progress to cardiac arrest if untreated. Scenarios. Transported to ED. This is exactly why my agency recommends PCPs use 2 mg IV naloxone in arrests with a possibility of narcotic overdose. Normally, drug patients don’t get the vip treatment. This will be your last of three graded scenarios. Patient transferred to Observation Room for overnight observations. Oropharyngeal airway – to protect the airway due to decreased level of consciousness, Pulse oximetry – to monitor oxygen saturation levels in the blood, Supplemental oxygen – to re-oxygenate patient after period of bradypnoea, 3 Lead ECG – to identify any life-threatening arrhythmias, Naloxone IM – to reverse the respiratory depression caused by narcotic overdose, Cooling of burns – to stop the burning process, Sterile dressings over burns – TBSA > 10% so water based dressings contraindicated, Fluid resuscitation – to re-hydrate the patient due to plasma loss caused by burns, 12 Lead ECG – to identify any life-threatening arrhythmias or ECG changes indicative of myocardial damage (secondary to hypoxia etc. And of course as you said, the transition zone is nearly always acutely painful. In 2014, th… Bazazi AR1, Zaller ND, Fu JJ, Rich JD. Number of patients: 1 . Your thoughts? Press question mark to learn the rest of the keyboard shortcuts, Natural Selection Intervention Specialist. That is the argued indication for giving naloxone. SCENE SIZE-UP Scene safety: Yes . Injuries sustained due to falls (40%), and assault while unconscious (14%) were other indirect morbidity factors reported. These scenarios do not necessarily require transport to the ED. For example, if EMS did not find the pill bottle, the ingestion becomes unknown. ] If we have POCUS and can rule out cardiac movement, narcan wouldn’t be indicated. With your Igel in place you do not need to worry about the patient's respiratory drive. You're signed out. It isn’t indicated for cardiac arrest of any etiology. Ambulance called for by doctor upon arrival at house. In the majority of the EU, drug related deaths have decreased, yet Ireland is still experiencing increases (EMCDDA, 2002). Preventing opiate overdose deaths: examining objections to take-home naloxone. PMID: 12144598. Post-ROSC, it means that you're not likely to see spontaneous respirations if he's still got crazy amounts of heroin swimming around his system. Opioid overdose on its own should be able to be managed with good airway management and ventilation, VF is best treated with defibrillation. When emergency medical services (EMS) arrived, he was found to have miosis and was cyanotic with respiratory depression. The first crew have found the patient … Im more concerned about the cocaine and would give bicarb, and assume sodium channel toxicitity. }); Brought directly to Resus room. Edit to add: with cocaine mixed into an arrest, I’m definitely not giving narcan. The State EMS Code (10NYCRR-800) requires that candidates for initial certification and recertification pass a New York State Practical Skills Examination (PSE), prior to admission to the New York State written certification examination. Each scenario goes through some discussion at the end including links to read more about the conditions and treatments included in the scenario. Patient received Naloxone infusion over 23 hours. Blood tests – to identify any electrolyte imbalances caused by fluid loss etc. They're not going to start breathing while in asystole after I give Narcan. [4/22/13] 720 Mass Ave — MVA. "Why not?" In a true cardiac arrest, narcan isn’t indicated. If I get rosc, sweet Ive already got a dose on board for an RSI. In addition, one for the comments, do you give narcan post ROSC? Press J to jump to the feed. High quality CPR and Defib when needed will be the only thing to save this patient. Administration of Naloxone for Opiate Overdose – EMT Optional Skill – Course Curriculum Page 8 of 10 01/2019 Definition: A procedure used by medical staff to prevent the spread of infection. bodyHandler: function() { He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. If playback doesn't begin shortly, try restarting your device. Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. Post arrest is a horrible time to administer narcan due to the hemodynamically unstable nature of a post-arrest ROSC patient. bodyHandler: function() { Along with members from the EMSC EMS Committee and pediatric advocates throughout the state, the Kansas Pediatric Scenario Guidebook was developed. Patient triaged as Category 1 (Life-Threatening Condition) with Burns, Overdose & Poisoning. EMT Scenario: M003 DISPATCH . Scenario Sunday – 2/16/14. Medic 3 arrives on scene to find a 36-year-old male patient supine on the living room floor. One shock delivered. NOI: Difficulty Breathing . The fuck am I going to give Narcan to an arrest for? OPA inserted and tolerated. Environment: Emergency Department treatment area: ... increase/decrease scenario difficulty. If they regain a pulse quickly once the hypoxia is corrected you could think about narcan, but otherwise I don't think it's really necessary. Primarily Intra-arrest, gotta go with the reversal of the sodium channel blockade. Warner-Smith M1, Darke S, Day C. Morbidity associated with non-fatal heroin overdose. It is estimated that injecting heroin users have a 20 to 30 time increased risk of dying when compared to non-users of the same age. Obviously countering hypoxia with O2 and ventilation as above. These scenarios were developed for use in EMT-I training programs in Alaska. Lisbon: EMCDDA, Kelly, A et al (2003) A 3 Source Capture/Recapture Study of the Prevalence of Opiate Use in Ireland 2000 to 2001. Usually associated with hyperventilation, hypoxia, anoxia, and hypercarbia Patient requires adequate ventilation Most seizures last 2-5 minutes. DISPATCH . So, you know 100% for sure that the pt is in VF arrest due to narcotic overdose. Dublin: National Advisory Committee on Drugs. For a PEA arrest with potentially reduced cardiac output, I think it's more reasonable to just manage the airway and see what happens. Narcan isn’t a cardiac arrest medication. Initial care for patients with a … Drugs and Alcohol Programme (2008) [http://www.drugs.ie/drugtypes/drug/heroin] Accessed 28/01/2014. Narcan is indicated for respiratory failure or arrest secondary to opioid use. PMID: 11302902. Addiction. NOI: Diabetic . The scenarios may be used with other curricula with little or no modification. Upon arrival you find a 65-year-old male lying on the bed. 1) The person facilitating scenarios can print out the pages below. You're the second crew on scene, backing up a car with a paramedic and a student. Sterile dressings placed over burns. So what analgesia for their burns in hospital? EMS providers are on the frontlines of an opioid overdose in the United States. The friend was unable to rouse patient. }, Patient is in recovery position upon arrival of crew. It will be worth 20 points total and a passing score is 15-20 points. He has previously worked and studied across Europe, North America and the Middle East. [4/1/13] Wellington Park — AMS. Here you can put your knowledge and skills to the test without risking any patient lives. Your unit has responded to a general sickness call. The first crew have found the patient to be in agonal respirations, with an initial rhythm of VF. It does nothing else. To estimate the range and severity of heroin overdose related morbidity. Withhold naloxone and continue with the established airway in situ. New comments cannot be posted and votes cannot be cast. EMT Scenario: M002. }); Tags: case study, drug, heroin, OD, overdose. Aggressive airway management, fluid resuscitation commenced. }); Suicide is the 11th leading cause of death in the U.S., and suicide attempts comprise more than 500,000 ED visits annually. jQuery(document).ready(function() { Shopping. Programs that distribute naloxone to opiate users and their acquaintances have been su […] Some typical signs of an opioid overdose include: Extreme sleepiness and inability to wake up I might consider it in a PEA arrest with a suspected opioid cause, strictly because they may have a pulse that is too faint to detect. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education. Urinary catheter – to monitor urinary output due to fluid resuscitation being commenced, and to ensure adequate renal function, Naloxone infusion – to  continue to reverse the respiratory depression caused by narcotic overdose, and to reduce opiate level in the body. In the meantime, ketamine might be a good choice? We're not supplied with monitors, so rhythm analysis is off the table; it's suggested on the off chance that the cardiac output is simply too low to produce a palpable carotid. Providing comprehensive prehospital care to overdose patients. All 10 showed a lack of treatment knowledge for overdose. Required BSI: Standard Precautions . I would definitely give Bicarb if sodium channel toxicity is in the mix (ie, wide PEA). This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Naloxone isn't going to add any good to the situation and has potential to cause harm (rarely). There are no upcoming events at this time. Preventing opiate overdose deaths: examining objections to take-home naloxone. Suddenly, your pager advises you differently, you spring from your bunk and answer your call. Paramedic? But I’d imagine opioids featured at some stage again post-infusion of naloxone. jQuery("#cit21099064").tooltip({ showURL: false Rapid Reviews: Vital signs in CVAs – which arm? Free access: Resuscitation Today Vol 3 Issue 2, Care at the Scene – Research for Ambulance Services, Canadian Paramedicine Feb/Mar 2016 – Open Access Issue, Eat, sleep and be healthy – a paramedic’s guide to healthier shift work, Free access: Resuscitation Today Volume 3 Issue 1, Introducing the Irish Journal of Paramedicine, Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice, Understanding diagnostic tests 1: sensitivity, specificity and predictive values, GRADE guidelines – best practices using the GRADE framework, How to get started with EMS research – JEMS. Work the arrest on scene and assess options with the AP. If they have a stable advanced airway/are being bagged appropriately, I'm really not sure what Narcan is going to do to help. He's almost certainly going to end up tubed in an ICU anyway so make it their problem where they'll either go supportive care until his body clears it itself, or have everything on hand to manage a pulmonary oedema if they do go down the naloxone path. Shameless Rip from a facebook group that is getting some mixed replies; You're a double paramedic crew, called to a 28 YOM in cardiac arrest, secondary to cocaine and heroin toxicity. Completely theoretically, narcan would be low on my priorities for reversing VF arrest in a 28yo regardless of history. EMCDDA (1997) 1997 Annual Report of the State of the Drugs Problem in the European Union. Found in a collapsed state by friend (also IV heroin user), lying naked in a bedroom against the radiator. Treat it as any other arrest. Narcan can be administered in addition the code meds but not first line and not in lieu of. This resource will walk your providers through a scenario containing vital signs, pertinent patient and call information, graphics, In a study carried out in Dublin, Ireland drug users agreed that overdose training should be provided to users (Bolger, 2007). If I get ROSC and they are apneic, I don't give a fuck, because I am already doing it for them. Alabama Paramedic Protocol Scenarios Alabama EMS Patient Care Protocols, Sixth Edition, June 2011 3 3.02 Abdominal Pain Protocol 1 Please read entire scenario as written. jQuery("#cit12144598").tooltip({ that may increase morbidity. You’re gonna reverse respiratory depression, sedation and hypotension in a patient who is in cardiac arrest? The goal is to reach asepsis, which means an environment medicationthat is free of harmful microorganisms. All prior scenarios will be listed here in running chronological order. First aid administered by GP prior to ambulance arrival. Heroin use, whilst at one time restricted to inner city Dublin, is now widespread throughout Ireland, most commonly smoked. Post-arrest gets an ICU ticket in my book, precedex as a first line sedative & ofirmev for pain, ketamine as second line sedative if blood pressure is forgiving. On admission to the emergency department, the patient had a systolic blood pressure of 95 mmHg, a diastolic blood pressure of 70, oxygen saturation was 84% on 100% nonrebreather mask, and respirati…