CC May 2016 Acute Opioid Intox

echoecho's version from 2016-07-24 16:07


Question Answer
What does a dx of an overdose of heroin or any opioid require on the part of the medical personnel?a high index of suspicion
Acute opioid intoxication is a ______ diagnosis made by a thorough physical exam with lab testing helping to r/o coexisting problems?clinical
In the case of a patient who is NOT responsive, what format (according to the American Heart Association) should be done to evaluate a nonresponsive person?CAB format ("Circulation, Airway, Breathing")
Once the patient has been stablished by the CAB format, what should be performed looking for signs of acute heroin / opioid intoxication?a more detailed exam
*** What are the classic findings of opioid intoxication?1) miosis 2) depressed mentation 3) respiratory depression (bradypnea and decreased tidal volume)
What additional findings point to opioid intoxication?1) bowel sounds are hypoactive 2) body temp may be normal, elevated or low depending on environmental conditions, level of obtundation or the presence of infection
List the signs of chronic drug use?1) needle marks 2) nasal septum perforation (from chornic intranasal cocaine use) 3) cardiac murmurs (a manifestation of endocarditis which is a frequent complication of chronic IV drug use) 4) soft tissues abscesses
Acute opioid intoxication is a _______ diagnosis?clinical
What blood work is performed as part of general work-up of an obtunded person?CBC, complete metabolic panel
Why is an EKG needed in work-up of acute opioid intoxication?to assess the heart rhythm as arrhythmias are a potential problem with mixed drug use (cocaine, TCAs) or if methadone is a concern (may cause QT prolongation)
The benefit of EKG in other cases of opioid intoxication is less clear, true or false?true
Why is a CT scan of the head needed in work-up of acute opioid intoxication?to r/o intracranial pathology
Ruling out ________ ingestion is crucial?polysubstance
*** A UDS and blood levels of what 2 levels are also a routine practice in any overdose case?1) acetaminophen 2) salicylate
*** While a UDS may help to r/o co-ingestion of other substances, should it be used alone as a guide to treatment?no
*** SUMMARY = Rarely do the results of the UDS affect ______ treatment in the case of acute opioid intoxication?immediate
Blood cultures are indicated only if there is a concern about what?1) endocarditis 2) other systemic infectious process
What blood test should be done for a patient who has been immobilized for a prolonged period of time and is at risk for rhabdomyolysis?CPK (creatine phosphokinase)
*** What is the treatment of acute intoxication with heoin or other opioids?mainly supportive
*** Close monitoring of vital signs is important, why?because some of the known side effects of opioid overdose are bradypnea, hypotension and bradycardia potentially leading to cardio-respiratory failure
*** What is the mainstay of treatment for acute opioid intoxication?respiratory support (special attention should be placed on respirations and oxygenation - utilizing supplemental oxygen and supportive ventilation as needed)
IV access is usually initiated to do what?maintain an adequate fluid status of the patient and to provide access for medication
What is the name of the rapid-acting, short duration opioid antagonist utilized in the management of opioid overdose?Naloxone (Narcan)
*** Naloxone (Narcane) is administered to improve the patient's _______ status, not to improve their ________?1) respiratory 2) mentation
Describe what Naloxone (Narcan) does to opioid receptors?1) Narcan binds very STRONGLY to opioid receptors and precludes opioids from binding to opioid receptors 3) displaces bound opioid molecules thus decreasing the opioid effect
Naloxone (Narcan) is indicated in unconscious patients in whom the respiratory drive is threatened, describe this type of patient?1) where respiratory rates < 10 breaths/minute 2) inability to manage secretions 3) ineffective oxygenation
What is the goal of treatment?1) restore normal ventilation and oxygenation 2) avoid mechanical ventilation
Will the Naloxone (Narcan) have an effect on a patient with no opioids in their system?no
The Naloxone (Narcan) dose should be enought to improve ______ status WITHOUT inducing what?1) respiratory 2) opioid withdrawal
List the routes that Naloxone may be given?1) IV 2) IM 3) subcutaneous (SQ) 4) nasal and inhalation
When available, medical personnel perfer what route due to rapid onset of action and predictable absorption?IV
What 2 routes are preferred for administration in the field or when an IV site is not available?1) IM 2) SQ
What are the disadvantages of IM and SQ routes?1) absorption by these routes is slower 2) elimination is delayed
What 2 other routes are a rarely used last resort?1) nasal inhalation 2) oral
Onset of action after Iv administraiton is <____ minutes and the opioid reversal effects will last between ____ to ____ minutes?2; 30; 90
Due to the short duration of action, the dose determined to be effective may be _______?repeated
Describe the initial dosing protocol?0.4 to 2.0 mg (IM, IV or a combination of IM/IV), with repeat administration every 2-3 minutes as needed in gradually increasing doses
Dosing is ____ with higher doses for those in more severe respiratory distress?empiric
What is the initial dose for patients in cardiopulmonary arrest?2 mg
Lower doses may be appropriate if the patient has what?spontaneous respirations
If the overdose is treated in a center where adequate ventilatory support is available, what dose can be used initially?a smaller dose may be used initially and repeated every 2-3 minutes until the desired correction of the respiratory status has occurred
If the event occurs in the field, it is better to use what dose, why?as large a dose as necessary to correct the respiratory problems
After administering ____ to _____ mg WITHOUT results, what should be considered?an alternative diagnosis
The use of Naloxone in the field and its generalized availability to the public (in an effort to reduce opioid overdose-related deaths) has become a topic of recent debate. What home autoinjector kit is an easy-to-use device intended to buy some time for the overdosed patient until help arrives?Evzio
*** What is the WHO recommendation regarding Naloxone (Narcan)?it gives a strong recommendation to the availability of Naloxone to individuals likely to witness an opioid overdose
What are being developed for EMS and family members or advocates with guidelines for appropriate use?concentrated intranasal preparations
List the side effects of Naloxone treatment as a direct results of a fast withdrawal of opioid effects from the body and sympathetic surge afterwards?1) HTN 2) agitation 3) tachycardia 4) seizures (less frequent but the caregive should be prepared to treat them if they occur)
Once the patient is stablized, the duration of intoxication is dependent on what?dose consumed
A heroin addict with long-term use may go through a withdrawal period that may start a few _____ to several ______ after the last time that person used heroin? Timing depends on the _____ of heroin used?hours; days; amount
List the symptoms of withdrawal of heroin use?1) restlessness 2) muscular pain 3) insomnia 4) diarrhea 5) vomiting 6) cold flashes with goose bumps (thus the colloquial term "cold turkey") 7) cravings for the drug
Are symptoms of withdrawal lethal?no (but they are extremely unpleasant)
What do detoxification programs available help with?1) minimizing withdrawal symptoms 2) helping patient develop coping skills that help them avoid relapse during this difficult period
*** SUMMARY = The prevalence of opioid intoxication and associated death has increased dramatically over the past few years due to the increased use of _____?heroin
*** SUMMARY = Define acute opioid intoxication?based ona high level of suspicion of drug abuse in the setting of a reduced level of consciousness or obtundation, respiratory depression and miosis
*** SUMMARY = What is treatment of opioid intoxication aimed primarily at?1) restoring respiratory function and oxygenation 2) supportive attention to cardiovascular and neurologic functions
*** SUMMARY = Rapid reversal of the effects of opioid intoxication can be achieved with the administration of what drug in the ER or potentially at home by a reliable advocate or family member?Naloxone (Narcan)