UMEM Educational Pearls

Title: How common is hematologic toxicity from copperhead bite?

Category: Toxicology

Keywords: hematologic toxicity, copperhead envenomation, bleeding (PubMed Search)

Posted: 8/1/2019 by Hong Kim, MD
Click here to contact Hong Kim, MD

 

Hematologic toxicity (coagulopathy/bleeding) can occur with pit viper envenomation. Copperhead is the most commonly implicated pit viper envenomation in the U.S. However, the prevalence of hematologic toxicity from copperhead envenomation is variable, possibly due to regional variation in venom potency and species misidentification. 

An observation study was performing using multi-center (Virginia Commonweath university, University of Virginia Medical Center and Eastern Virginia Medical medical center) electronic hospital/medical records (Jan 1, 2006 to Dec 31, 2016) of suspected copperhead bites. Authors state that copperhead snakes are "nearly exclusively endemic" to the VCU and UVA medical center region.

 

Results:

388 patients were identified but 244 met inclusion/exclusion criteria.

  • Mean age: 34 years
  • Male: 59%
  • Antivenom administration: 76%
  • No bleeding was reported.

 

Hematologic toxicity: 14%

  • Elevated PT: 10.0%
  • Elevated PTT: 3.9%
  • Thrombocytopenia: 1.2%
  • Hypofibrinogenemia: 0.7%

 

Conclusion

In a small sample of copperhead envenomation in Virginia, “subtle” hematologic abnormalities were observed but clinically significant hematologic toxicity was not observed (i.e. bleeding)

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Title: Extubation Criteria

Category: Critical Care

Keywords: Mechanical Ventilation, Intubation, Extubation, RSBI (PubMed Search)

Posted: 7/28/2019 by Mark Sutherland, MD (Updated: 7/30/2019)
Click here to contact Mark Sutherland, MD

With increasing critical care boarding and the opioid crisis leading to more intubations for overdose, extubation - which was once a very rare event in the ED - is taking place downstairs more often.  Prolonged mechanical ventilation is associated with a ton of complications, so it's important for the ED physician to be comfortable assessing extubation readiness.  There is no single accepted set of criteria, but most commonly used are some variant of the following:

  • Reason for intubation (e.g. overdose, pneumonia, pulmonary edema, AMS, etc) has resolved
  • Minimal vent settings - Typically FiO2 < 40%, PEEP <= 5
  • Spontaneous breathing present (i.e. pt breathes with reasonable rate on PS, SIMV, VS, PPS, etc) and able to maintain reasonable pH and pCO2 on these settings
  • Neuromuscular function adequate - Ask patient to lift head off bed
  • Mental status adequate - Ask patient to give thumbs up or squeeze hands
  • Secretions tolerable - Ask RN or RT for frequency of suctioning and sputum character.  Think twice about extubation if getting purulent, thick secretions every 15 minutes.
  • Clinical course does not require further intubation (i.e. no immediate trips planned to OR, MRI; pt not hemodynamically unstable, etc.)

If the above criteria are met, two additional tests are frequently considered:

  • Spontaneous Breathing Trial (SBT) - Typically done by placing pt on PS with low settings (0/0 to 5/5).  Let pt equilibrate (time of SBT is variable) on these settings, then calculate RSBI (RR/Vt). RSBI < 105 is traditionally considered acceptable for extubation.  Remember - lower is better.  Ask RT for this. 
  • Cuff Leak Test - becoming less popular, but may consider in patients at risk for laryngeal edema (e.g. prolonged intubation, angioedema, etc). Historically thought to predict airway swelling, but data is mixed.  Ask RT for this.

And don't forget to consider extubating high risk patients directly to BiPAP or HFNC!

 

Bottom Line: For conditions requiring intubation where significant clinical improvement may be expected while in the ED (e.g. overdose, flash pulmonary edema, etc), be vigilant about, and have a system for, assessing readiness for extubation.

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Title: Bone stress injury (BSI) in Adolescents

Category: Orthopedics

Keywords: Bone stress reaction, fracture, overuse injury (PubMed Search)

Posted: 7/27/2019 by Brian Corwell, MD
Click here to contact Brian Corwell, MD

Bone stress injury (BSI) in Adolescents

 

A BSI occurs along a pathology continuum that begins with a stress reaction and may progress all the way to a stress fracture.

Difficult to diagnose clinically.

Identifying risk factors as part of the history is very important.

Common sites for BSI are most frequently in the lower extremity and include the tibia, fibula, tarsals and metatarsals, calcaneus, and femur.

When considering this in an ED setting, image the involved area and if there is no fracture, advise discontinuing the activity until time of PCP/sports medicine follow up. For those with rest pain, pain with minimal weight bearing or in whom a fracture was suspected but not present, consider providing a walking boot or crutches.

BSIs occur more frequently in young athletes than in adults.         

          Almost 50% of BSIs occur in those younger than 20 years of age

Primary care and sports medicine providers are seeing more of these patients due to many factors.

Year-round training, sports specialization at younger ages and increase in training intensity/duration contribute to the increase incidence in adolescents.

Not surprisingly, participation in organized sports as an adolescent is a known risk factor.

Just as a change in sporting level from high school to college is a known risk factor for BSI, young “gifted” athletes who are promoted to competing with the varsity team may be at similar risk.

Shin pain lasting more than 4 weeks may represent a unique subset of MSK pain complaints increasing risk of BSI.

A prior history of BSI is a strong predictor of future BSI.

Inquire about night pain, pain with ambulation, and pain affecting performance.

Athletes with BSIs have a significantly lower BMI than controls (<21.0 kg/m2).

Athletes with BSIs sleep significantly less than controls.

Athletes with BSIs have significantly lower dairy intake than controls.

Inquire about components of the female athlete triad (low energy availability, menstrual dysfunction and low bone mineral density)

 

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The incidence of empyema as a complication of pneumonia has been increasing since the 1990's and source control requires removing the pus from the chest as soon as possible, but how large should the drain be? The American Association for Thoracic Surgery (AATS) released the most recent guidelines for identifying and managing empyema in June 2017 and at the time had no certain evidence to guide the choice of large-bore vs small-bore catheters. Most studies to guide us are flawed (not randomized), but no recently published randomized studies exist to provide a definitive answer. 

Bottom line: a small-bore pigtail catheter is a reasonable choice to drain empyema and flushing it every 6 hours has been shown to prevent clogging.

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Title: Status epilepticus medication management in children

Category: Pediatrics

Keywords: Keppra, Dilantin, status epilepticus (PubMed Search)

Posted: 7/20/2019 by Jenny Guyther, MD (Updated: 11/12/2024)
Click here to contact Jenny Guyther, MD

-Benzodiazepines alone are effective in terminating status epilepticus in 40 to 60% of pediatric patients

-The guidelines for second line agents are based on observational studies and expert opinion

-Adverse effects of phenytoin include hepatotoxicity, pancytopenia, Stevens-Johnson syndrome, extravasation injuries, hypotension and arrhythmias

- Levetiracetam has a reduced risk of serious adverse events, greater compatibility with IV fluids and can be given in 5 minutes versus 20 minutes for phenytoin.

 

Bottom line: In a recent randomized control trial they found that levetiracetam was not superior to phenytoin as a second line agent for management of convulsive status epilepticus in children.  There was no difference between efficacy or safety outcomes between the two groups.

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Title: Pulmonary complication from reversal of opioid overdose with naloxone

Category: Toxicology

Keywords: naloxone, pulmonary edema, aspiration, overdose (PubMed Search)

Posted: 7/19/2019 by Hong Kim, MD
Click here to contact Hong Kim, MD

 

Pulmonary complications - aspiration, pulmonary edema, etc. are frequently reported in both heroin intoxication and in reversal of opioid overdose with naloxone. 

Suspected opioid overdose victims (N=1831) who received naloxone from EMS providers were studied retrospectively. Pulmonary complications were defined as pulmonary edema, aspiration pneumonia and aspiration pneumonitis.

Results

  • Out of hospital naloxone dose > 4.4 mg – 62% more likely of experiencing pulmonary complication (OR 2.14, 95% CI: 1.44 to 3.18) 
  • Increased risk of pulmonary complication if initial naloxone dose is > 0.4 mg (OR 2.57, 95% CI 1.45 to 4.54)

 

Conclusion

Higher out of hospital naloxone administration is associated with increased odds of developing pulmonary complications

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POCUS in the Critically Ill Pregnant Patient

  • POCUS can be a valuable tool in the assessment and management of critically ill pregnant patients.
  • Conditions to consider in the critically ill pregnant patient who presents with acute RUQ pain include acute fatty liver of pregnancy (AFLP), liver infarction, liver hematoma, and Budd-Chiari Syndrome.
  • POCUS findings for these conditions include:
    • AFLP: a "bright" liver
    • Infarction: a wedge-shaped hypoechoic area (late finding)
    • Hematoma: a heterogeneous fluid collection below the capsule or intraparenchymal
    • Budd-Chiari Syndrome: lack of blood flow or thrombus in a hepatic vein or within the IVC.

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Long head of biceps tendon (LHBT) Testing

 

Overhead activities can cause anterior shoulder pain due to LHBT instability. A review of 3 physical exam maneuvers for bedside evaluation.

 

Speed test

Shoulder at 90° of flexion with arm fully supinated and elbow extended

Patient attempts to fwd. elevate arm against a downward force

Positive test is pain localized to bicipital groove.

Sensitivity 54% and specificity 81% for biceps pathology

https://youtu.be/N00gA4Pvsbw

 

Yergason test

Elbow at 90° of flexion with arm fully pronated and held against thoracic wall. Examiner grips patient’s hand and resists attempts at supination.

Positive test is pain localized to bicipital groove or LHBT subluxation.

Sensitivity 41% and specificity 79% for biceps pathology

https://youtu.be/_ot2S75mZ3o

 

Upper Cut test

Shoulder neutral with Elbow at 90° of flexion, arm fully supinated and hand in a fist. Patient moves hand toward chin in an uppercut motion like a boxer. Examiner places hand over patient’s fist and resists upward movement.

Positive test is pain localized to bicipital groove or LHBT subluxation.

Sensitivity 73%, specificity 78%, +LR 3.38 for biceps pathology

https://youtu.be/EE-WhlWFZvk

 

 

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Title: Human errors involving "push dose pressors"

Category: Toxicology

Keywords: push dose pressor, phenylephrine, epinephrine, human error (PubMed Search)

Posted: 7/11/2019 by Hong Kim, MD
Click here to contact Hong Kim, MD

 

“Push dose pressors” – administration of small doses of vasopressors in the emergency room has become a common practice. A recently published study investigated the incidence of human error and adverse hemodynamic events.

Push dose pressors were defined as:

  • Phenylephrine (any dose)
  • Epinephrine (<= 100 mcg) 

Adverse hemodynamic event was defined as:

  • Extreme tachycardia (HR > 140 bmp)
  • New bradycardia (HR < 60 bmp)
  • Hypertension (SBP > 180 mmHg)
  • Ventricular tachycardia

249 out of 1522 patients were identified and analyzed from Jan 2010 to November 2017

  • median initial epinephrine dose (20 mcg; IQR: 10-100; range 1-100)
    • recieved more than one dose: 78 (57%)
  • median initial phenylephrine dose (100 mcg; IQR: 100-100; range 25 to 10,000)
    • received more than one dose: 62 (56%)

Adverse event

  • Phenylephrine group (n=110): 30 (27%; 95% CI: 19-36%)
  • Epinephrine group (n=139): 68 (50%; 95% CI: 41-58%)

Errors

  • Human error: 47 (19%) - similar proportion of human error between two agents.
  • Dosing error: 7 (3%; 2.5 to 100-fold)
  • Documentation error: 43 (17%)
  • Only one dosing error occurred when a pharmacist was present

 

Conclusion

  • Human errors and adverse hemodynamic event were common when “push dose pressors” were administered.
  • Consultation with a pharmacist can/may reduce dosing error.

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Title: SNOOP for Headache Red Flags

Category: Neurology

Keywords: secondary headache, features, risk factors, red flags (PubMed Search)

Posted: 7/10/2019 by WanTsu Wendy Chang, MD
Click here to contact WanTsu Wendy Chang, MD

 

  • Symptoms/signs that suggest serious underlying conditions causing headaches are summarized by the mnemonic SNOOP:
    • Systemic symptoms/signs/disease
      • e.g. fever, weight loss, HIV, malignancy, pregnancy
    • Neurologic symptoms/signs
      • e.g. altered mental status, diplopia, pulsatile tinnitus, loss of consciousness
    • Onset sudden, abrupt, thunderclap
      • i.e. pain reaches maximal intensity instantly after onset
    • Older age of onset, especially > 50 years
    • Pattern change
      • e.g. change in frequency, severity, clinical features, precipitated by Valsalva, aggravated by postural change
  • Consider structural pathologies, vascular disorders, infectious and inflammatory conditions in the evaluation of secondary headache syndromes.

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Title: Push dose epinephrine alternatives

Category: Critical Care

Keywords: Critical Care, Hypotension, Shock, Vasopressors (PubMed Search)

Posted: 7/9/2019 by Mark Sutherland, MD (Updated: 11/12/2024)
Click here to contact Mark Sutherland, MD

With a shortage of push dose epi, this may be an opportune time to review alternative options (see also Ashley's email on the subject).

The dose of vasopressor required to reverse hypotension has been most studied in pregnant women undergoing c-section who get epidurals and experience spinal-induced vasoplegia and hypotension (not necessarily our patient population, but we can extrapolate...)  

Phenylephrine was found to reverse hypotension 95% of the time at a dose of 159 micrograms (a neo stick has 100 ug/mL, so around 1-2 mL out of the stick)

Norepinephrine reversed hypotension in 95% of patients at a dose of 5.8 ug.  The starting dose for our norepi order in Epic is 0.01 ug/kg/min, so if you have a levophed drip hanging and have an acutely hypotensive patient, you may want to briefly infuse at a higher rate such as 0.1 ug/kg/min (for a typical weight patient), or bolus approximately 3-7 ug for a typical patient.  Of course the degree of hypotension, particular characteristics of your patient and clinical context should be taken into consideration.  When your a lucky enough to have this resource, always consult your pharmacist.

 

Bottom Line: To reverse acute transient hypotension you may consider:

-A bolus of phenylephrine 50-200 ug (0.5-2 mL from neo-stick)

-A bolus of norepinephrine 3-7 ug

-Briefly increasing your norepinephrine drip (if you have one) to something around 0.1 ug/kg/min in a typical weight patient

-Always search for other causes of hypotension and consider clinical context.

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Title: Alteplase for Pulmonary Embolism

Category: Pharmacology & Therapeutics

Keywords: alteplase, pulmonary embolism (PubMed Search)

Posted: 7/6/2019 by Wesley Oliver
Click here to contact Wesley Oliver

Alteplase may be considered in some patients with a presumed or confirmed pulmonary embolism.  Below is a list of the different patient populations and the associated alteplase dosing.

-Hemodynamically Stable/Submassive: Alteplase usually not indicated.

-Hemodynamically Unstable/Massive: Alteplase IV 100 mg as an infusion over 2 hours.

-Cardiac Arrest: Alteplase IV/IO 50 mg bolus over 2 minutes.  Can repeat a second 50 mg bolus 15 minutes later if unable to achieve return of spontaneous circulation.

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Title: Sudden Sniffing Death

Category: Toxicology

Keywords: Sudden sniffing death, Inhalants, Fluoridated Hydrocarbons (PubMed Search)

Posted: 6/27/2019 by Kathy Prybys, MD (Updated: 7/5/2019)
Click here to contact Kathy Prybys, MD

Volatile inhalants such as glue, lighter fluid, spray paint are abused by "sniffing" (from container), "huffing" (poured into rag), or "bagging" (poured into bag). "Dusting" is the abuse of canned air dust removal products. These inexpensive easliy accessible products are so dangerous  that manufacturers include product warnings regarding lethal consequences from misuse and even may indicate that a bitterant is added to discourage use. Common duster gases include the halogenated hydrocarbons, 1,1-difluoroethane or 1,1,1-trifluroethane which are highly lipid soluble and rapidly absorbed by alveolar membranes and distributed to CNS. Desired effect of euphoria and disinhibition rapidly occur but unwanted side effects include confusion, tremors, ataxia, pulmonary irritation, asphyxia and, rarely, coma.

"Sudden sniffing death" is seen within minutes to hours of use and is due to ventricular arrhythmias and cardiovascular collapse. Available experimental evidence postulates the following mechanisms: Inhibition of cardiac sodium, calcium, and repolarizing potassium channels hERG and I(Ks) causing reduced conduction velocity and altered refractory period leading to reentry arrythmias or myocardial "sensitiization" to catecholamines resulting in after depolarizations and enhanced automaticity. Treatment should include standard resuscitation measures but refractory arrythmias to defibrillation have been reported and use of amiodarone and beta blockers should be considered.

 

Bottom Line:

  • Volatile Inhalant Abuse is common and dangerous 
  • SSD can occur even with first use
  • Ventricular arrythmias can be refractory to electricity. Consider amiodarone and beta blockers.

 

 

Ultra Duster Aerosol with Trigger, 12 oz

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Title: Don't miss the injecting drug users with botulism!

Category: Critical Care

Keywords: IVDA, AMS, botulism, Tox, ID (PubMed Search)

Posted: 7/2/2019 by Robert Brown, MD (Updated: 11/12/2024)
Click here to contact Robert Brown, MD

Wound botulism presents as descending paralysis when Clostridium botulinum spores germinate in anaerobic necrotic tissue. There have been hundreds of cases in the last decade, but it is poorly reported outside of California.

Black tar heroin and subcutaneous injection (“skin popping”) carry the highest risk, but other injected drugs and other types of drug use suffice. C botulinum spores are viable unless cooked at or above 85°C for 5 minutes or longer and this is not achieved when cooking drugs. 

Early administration of botulism anti-toxin (BAT) not only saves lives but can prevent paralysis and mechanical ventilation. An outbreak of 9 cases between September 2017 and April 2018 cost roughly $2.3 million, in part because patients didn’t present on average until 48 hours after symptom onset and it took an additional 2-4 days before the true cause of their respiratory depression and lethargy were understood. One patient died.

PEARL: talk to your injecting drug users about the symptoms of botulism: muscle weakness, difficulty swallowing, blurred vision, drooping eyelids, slurred speech, loss of facial expression, descending paralysis, and difficulty breathing. Consider botulism early in your patients who inject drugs but who do not respond to naloxone or who exhibit prolonged symptoms. Testing at the health department is performed with mouse antibodies to Botulism Neurotoxin (BoNT) combined with the patient’s serum.

 

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Title: Cyanide antidote in the pipeline (submitted by James Leonard, PharmD)

Category: Toxicology

Keywords: cyanide toxicity, sodium tetrathionate, (PubMed Search)

Posted: 6/27/2019 by Hong Kim, MD
Click here to contact Hong Kim, MD

 

Cyanide poisoning, while uncommon, is frequently fatal. Current antidotes include methemoglobinemia inducers (nitrites), sulfur donators (thiosulfate), and hydroxocobalamin. Each has risks and benefits that must be considered. Three new potential antidotes, including sodium tetrathionate, have recently been evaluated in swine models.

 
Intramuscular sodium tetrathionate1

  • Sodium tetrathionate can bind and eliminate two cyanide molecules compared to one cyanide molecule by thiosulfate.
  • Studied in a large (50 kg) female swine model of cyanide poisoning.
  • All pigs were given cyanide via IV until 6 minutes post-onset of apnea, then given an approximately 1.5 mL IM injection of sodium tetrathionate (18 mg/kg).
  • Survival at 90 minutes was 100% (6/6) in the treated group and 16% in the control arm (1/6). 

Advantages:

  • Small volume injection (~1.5-2 mL in humans)
  • No interference with routine laboratory tests.
  • Ease of administration in pre-hospital or potential mass casulty setting.

Bottom line:

  • New cyanide antidotes are being developed.
  • The FDA does NOT require human trials of efficacy for cyanide antidotes.
  • It is unclear where these drugs are in the approval process at this time, but look for them in the future.

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Title: All this is giving me a headache!

Category: Neurology

Keywords: analgesia, headache, opioids (PubMed Search)

Posted: 6/26/2019 by Danya Khoujah, MBBS
Click here to contact Danya Khoujah, MBBS

Primary headaches (not secondary to a life-threatening disease) can be challenging to manage. Remember the following pearls:

  • Things that DO NOT work: IV fluids, 5-HT3 Antagonists (aka Zofran), diphenhydramine (aka Benadryl), opioids

  • Things that KINDA work: oxygen for all headaches, sphenopalatine ganglion block (4% lido spray) 

  • Things that REALLY work: ketorolac, metoclopramide, prochlorperazine, triptans and ergots, oxygen for cluster headaches
  • Things that PREVENT recurrence: dexamethasone for migraine headaches 



Title: Pediatric back pain

Category: Orthopedics

Keywords: Disc, infection, back pain (PubMed Search)

Posted: 6/22/2019 by Brian Corwell, MD (Updated: 11/12/2024)
Click here to contact Brian Corwell, MD

Children are prone to inflammation and infection of the intervertebral discs

-Mean age 3-5years at presentation.

 

Lumbar region frequently involved

 

Although disc biopsy is not necessary for diagnosis, as many as 60% of biopsied discs grow bacteria

-Usually Staphylococcus aureus.

 

Untreated - may spontaneously resolve or progress to vertebral osteomyelitis or abscess

 

Chief complaint: Back pain and irritability, often associated with a limp or refusal to crawl or walk.

Fever is absent or low grade. 

Physical examination findings are nonspecific and may include a tendency to lie still and percussion tenderness over the involved spine.

Blood culture is generally sterile,

WBC count can be normal early in the disease course

 

However, the ESR is elevated in >90% of patients.

 

Plain radiographs are normal at the start of the illness, and generally take 2-3 weeks to demonstrate narrowing of the intervertebral space.

 

Therefore imaging study of choice is MRI.

 

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Title: When to operate for complicated pediatric appendicitis

Category: Pediatrics

Keywords: appendicitis, hospitalization, operative management (PubMed Search)

Posted: 6/21/2019 by Jenny Guyther, MD
Click here to contact Jenny Guyther, MD

The 30-day adverse event rate is 11% after surgical removal of acute appendicitis.  Some experts believe that acute appendicitis actually consists of 2 types: Uncomplicated appendicitis and complicated appendicitis.  Complicated appendicitis can be broken down into appendicular abscess, appendicular phlegmon, and free perforated appendicitis with generalized peritonitis.
No consensus exists among surgeons regarding the optimal treatment of complicated acute appendicitis in children.  This study hoped to differentiate the complication rates between perforated appendicitis, appendicular abscess, and appendicular phlegmon with regards to early appendectomy versus conservative management.
14 studies were included in this meta-analysis for a total of 1288 patients. 
- Children with appendicular abscess and appendicular phlegmon had fewer complication rates and readmission rates if treated with nonoperative management.  
- Children with free perforated appendicitis showed lower complication rate and readmission rate if treated with operative management.  
- The costs were not significantly different between nonoperative management and operative management.

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Title: Intranasal administration of naloxone for suspected opioid overdose

Category: Toxicology

Keywords: intranasal naloxone, opioid overdose, reversal (PubMed Search)

Posted: 6/19/2019 by Hong Kim, MD
Click here to contact Hong Kim, MD

 

Naloxone distribution programs have been expanding to promote the naloxone adminstration by laypersons, usually intranasal (IN) device, to victims of opioid overdose. A recent study analyzed the reports of prehospital naloxone administration reported to a regional poison center.

  • 1139 cases of prehospital naloxone administrations were identified between 2015 and 2017.
  • 98.2% had ventilatory depression
  • 97% were unresponsive
  • Law enforcement officers administered 91% of the naloxone, 97.9% via IN route

 

Opioid toxicity revesal:

  • Opioid-induced ventilatory or CNS depression was reversed in 79.2% after administering a mean naloxone dose of 3.12 mg. 
  • EMS administered additional naloxone (mean dose: 2.2 mg) to 291 due to lack of or partial reversal of opioid toxicity. 
  • 254 out of 291 (92.4%) regained normal/improved mental and ventilatory status.  
  • 95.9% of the overdose victims survived.

 

However, between 2015 and 2017, the reversal rate decreased (82.1% to 76.4%) while mean administered naloxone dose increased (2.12 mg to 3.63 mg). The cause of this trend is unknown but the dose of commercially available IN naloxone kit increased from 2 mg to 4 mg in 2016.

 

Bottom line:

  • IN naloxone administration is an effective intervention to reverse opioid toxicity.
  • However, larger naloxone doses were administered between 2015 and 2017 while the reversal rate decreased.
  • It is essential for bystander/witness of overdose to notify EMS as overdose victims may require additional naloxone administration/medical attention.

 

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Post-Arrest Prophylactic Antibiotics?

  • Pneumonia is the most common infective complication in post-cardiac arrest patients. It may develop in up to 60% of patients and is associated with an increased ICU length of stay.
  • Given the challenges in diagnosing pneumonia in the post-cardiac arrest patient, many clinicians consider prophylactic antibiotic administration.
  • A recent systematic review and meta-analysis sought to evaluate the effect of early antibiotic use on survival and survival with good neurologic outcome in adult patients resuscitated from cardiac arrest. Key study results include:
    • 11 studies (3 RCTs, 8 observational trials)
    • 6149 patients
    • No change in overall survival or survival with good neurologic outcome
  • Take Home Point: Current data does not support the prophylactic administration of antibiotics to adults resuscitated from cardiac arrest.

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