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Palliative Care
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Signs of severe opioid overdose are loss of consciousness and respiratory rate less than 8 breaths per minute. It is extremely important to be aware that these signs may be present in an imminently dying patient from the underlying disease, so assess carefully before attributing to opioids. Opioids should not be withdrawn or antagonised if the patient is imminently dying. If overdose is suspected, stop the opioid and consider naloxone 400 μg to 2 mg in 200 μg increments. The effects of naloxone only last a short time, so close observation is necessary, and the patient may require repeated doses. Naloxone may precipitate a pain crisis and cause opioid-withdrawal symptoms, hence the importance of avoiding in imminently dying patients. If required, start with low doses of naloxone (aim to reverse the toxicity but not the analgesic effect).
Naloxone Use in the Opioid Epidemic
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Overdoses can be the result of ingesting “cocktails” including opioids, alcohol, benzodiazepines, muscle relaxers, and sometimes stimulants. Naloxone will only reverse the opioid part of the overdose and does not work on alcohol, stimulant, or benzodiazepine overdoses. If first responders are unsure if opioids are in any way involved with an unresponsive person, it is recommended to give the person naloxone while waiting for EMS to arrive.
Central nervous system depressants
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
Repeated use of substances such as heroin, oxycodone and buprenorphine induces a state of dependency with a need for increased doses and increased frequency of use. The occurrence of withdrawal symptoms triggers further use to relieve these symptoms. Repeated injections result in collapsed veins, infection of the heart lining and valves, and skin and muscle infections. Sharing injection equipment with other people carries a high risk of blood-borne infections, such as HIV and hepatitis C. Opioids depress coughing, breathing, and heart rate, dilate blood vessels, reduce bowel activity and produce constipation. Overdose usually occurs in combination with other drugs.
Opioid harm reduction: A scoping review of physician and system-level gaps in knowledge, education, and practice
Published in Substance Abuse, 2022
Emma Gugala, Owanate Briggs, Leticia R. Moczygemba, Carolyn M. Brown, Lucas G. Hill
All studies assessing knowledge focused on clinical knowledge. Clinical knowledge topics included overdose treatment and prevention (15 studies, 60.0%), OUD treatment (13 studies, 52.0%), and syringe and needle use (one study, 4.0%). Knowledge of overdose treatment and prevention commonly included the effectiveness of naloxone, in addition to prescribing and counseling.22–32 Physicians were found to be lacking in knowledge or training in overdose education and naloxone distribution. Fewer studies found that physicians felt unprepared to discuss medications for OUD treatment, including buprenorphine and methadone.8,33–38 These studies found that physicians with experience or higher knowledge of OUD treatment were more likely to support and practice this harm reduction activity.33–35,37,39–41 Additionally, two studies (8.0%) identified gaps in policy knowledge among physicians. These studies found that physicians were unaware of state laws regarding naloxone, such as standing orders and third-party prescribing, and substance use services that are available through the Affordable Care Act.39,42
Role of cinnamon oil against acetaminophen overdose induced neurological aberrations through brain stress and cytokine upregulation in rat brain
Published in Drug and Chemical Toxicology, 2022
Mohammad Ashafaq, Sohail Hussain, Saeed Alshahrani, Osama Madkhali, Rahimullah Siddiqui, Gulrana Khuwaja, M. Intakhab Alam, Fakhrul Islam
Acetaminophen (N-acetyl-p-aminophenol, APAP) is frequently used as a treatment for mild pain executioner and antipyretic. It is clinically effective at optimal recommended doses. The therapeutic dose of APAP prevents the formation of 1-methyl-4-phenylpyridinium in Parkinson’s disease and other neurodegenerative ailments (Locke et al.2008). However, long-term use, accidental overdose, or deliberate use may cause liver, kidney, and brain damage or organ failure in severe cases (Eakins et al.2015, Onaolapo et al.2017). Therefore, a prescribed dosage of APAP is critical to decide whether it encourages clinical or toxic effects. According to a recent scientific improvement, a high dose of APAP quickly enters into the brain where it accumulated and increased as compared to other sections such as serum (Kumpulainen et al.2007, Viberg et al.2014). Apoptotic event and oxidative damages have been reported in cortical neurons of the rat’s brain when a high dose of APAP was administered due to its neurotoxic effect (Posadas et al.2010, Temocin et al.2017).
Utilization of a poison control center by critical access hospitals—one state’s experience
Published in Clinical Toxicology, 2021
Connor Bowman, Stephen Thornton, Lisa Oller, Elizabeth Silver
It may be that UH call the PCC more frequently for cases that are more severe or unfamiliar and do not call as routinely for more frequent and familiar overdoses such as opioids or acetaminophen. This could be reflected by an increased use of ICU and toxicologist consults for UH patients who are more likely to have more severe outcomes following intentional overdose. In contrast, clinicians at CAH may call more frequently for less toxic exposures because they do not have as much experience in managing patients with toxic exposures. Additionally, the data that the PCC collects for each case may vary because of variations between poison specialists, variations between clinicians at UH and CAH, and differences in available history or other pertinent information. While not captured in this study, the type of clinician (e.g., physician vs nurse) that initially calls or follows up with PCC may differ between CAH and UH, which could cause further variation in data collection. Furthermore, an overdose patient can frequently present with limited or no available history of toxic ingestion or leave against medical advice before a final outcome can be documented.