Specific Diseases and Procedures
Michele Barletta, Jane Quandt, Rachel Reed in Equine Anesthesia and Pain Management, 2023
Drugs. Combine with cardiac massage epinephrine 0.01 mg/kg IV.Doxapram is a respiratory stimulant and also will partially antagonize sedation from xylazine or detomidine passed through the placenta from the mare. Inject 0.5 mg/kg, approximately 1.25 ml for a large foal, intravenously.Antagonism of drugs administered to the mare that may have crossed to the foal. Naloxone is an opioid antagonist. Inject 0.01 mg/kg, approximately 1.0 ml (0.4 mg/ml, for a large foal). Atipamezole will antagonize an alpha-2 agonist sedative.Dopamine and dobutamine are cardiovascular stimulants. Dopamine is more effective for resuscitation because it increases heart rate in addition to myocardial contractility. Add 50 mg dopamine (1.25 ml of 40 mg/ml) to 500 ml saline to make a solution of 100 µg/ml. Infuse IV at 7–10 µg/kg/min; for a 50 kg/110 lb foal, 8 µg/kg/min using a 15 drops/ml administration set is one drop/second.Tactile stimulation by rubbing with a towel; tickle inside the nostrils and ears and the perineum.
Drug Overdoses during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
Naloxone, an opioid-specific antagonist, is available and used as antidote. Naloxone competitively binds to opioid receptors and opioid analgesics, blocking uptake. Naloxone causes an almost immediate onset of withdrawal symptoms in patients addicted to opioids. In those patients not addicted to opioids, naloxone reverses the CNS and respiratory depression. Most narcotic analgesic preparations also contain other substances, such as acetaminophen and/or aspirin. In documented opioid overdose is encountered, naloxone should be given according to directions in the manufacturer’s package insert. Opioids cross the placenta freely and affect the fetus. Accordingly, naloxone acts as a fetal antidote as well. Therefore, treatment of maternal overdose will treat the fetal overdose.
Naloxone Use in the Opioid Epidemic
Sahar Swidan, Matthew Bennett in Advanced Therapeutics in Pain Medicine, 2020
When an overdose is suspected, naloxone should be used within 4–6 minutes to prevent major brain damage or death, making it a critical component in combating the opioid crisis. It generally takes effect within a few minutes and lasts for 30–90 minutes, depending on the individual’s metabolism and the amount of opioid used. Because its antagonism is short-lived, repeat doses may be needed when long-acting opioids are involved, or if there is an insufficient response. Activating EMS 911 is critical and should be done immediately as medical management is necessary after overdose. Naloxone can precipitate opioid withdrawal if large doses are given. The person being revived may wake up combative and have other side effects due to withdrawal, which are generally not life-threatening. Additional signs of acute withdrawal include agitation, tachycardia, nausea, vomiting, piloerection, diarrhea, lacrimation, yawning, rhinorrhea, and hyperhidrosis. These symptoms tend to dissipate after 30–60 minutes due to the relatively short half-life of naloxone.9 Naloxone cannot be abused and does not produce euphoria. In cases of maternal opioid overdose during pregnancy, naloxone use is safe and recommended as a life-saving measure; however, induced withdrawal may contribute to fetal distress.10 Allergic reactions to naloxone are rare.
Prehospital Naloxone Administration Patterns during the Era of Synthetic Opioids
Published in Prehospital Emergency Care, 2023
Andrew Liu, Alexander R. Nelson, Matthew Shapiro, Jeffrey Boyd, Geneva Whitmore, Daniel Joseph, David C. Cone, Katherine Couturier
The opioid crisis was declared a public health emergency by the US Department of Health and Human Services in 2017 (1). On average, 128 people die every day from opioid overdoses, with one study finding that the average opioid use disorder patient lost 18.3 years of potential life before age 65 (2, 3). The Centers for Disease Control and Prevention describe three waves of opioid overdose deaths. The current wave, beginning in 2013, has involved increasing contamination by synthetic opioids such as fentanyl (4–6). Fentanyl is around 50 times more potent than heroin and is thought to have contaminated the local supply of heroin in most areas of the United States. This contamination is theorized to be responsible for increasing deaths due to opioid use (6–8). Preliminary data for 2021 found 71,238 opioid-related deaths due to synthetic opioids (9). Regions with increased opioid overdoses also have increased naloxone use due to its role in preventing fatal overdoses (10, 11). Naloxone can be administered by intravenous (IV), intramuscular (IM), subcutaneous, or intranasal (IN) routes. It has been shown using pre- and post-intervention GCS scores and respiratory rates that basic life support (BLS) personnel are as effective as advanced life support (ALS) personnel in reversing opioid overdoses safely using IN naloxone (12, 13).
The Safe Passages program as approach to combat the heroin epidemic: case of Will County, IL
Published in Journal of Substance Use, 2023
Karl Jurgens, Mary Bruce, Natalia Ermasova, Andre Ashmore
Police officers commonly arrive at emergency scenes first, regardless of the nature of the call. Police officers already receive a basic knowledge of medical first aid and seconds become a precious commodity when an individual is not breathing due to drug overdose. It stands to reason to arm police officers with naloxone – another tool to help combat heroin overdoses. Naloxone is an opiate antagonist that once administered, immediately blocks the receptors in the brain that receive the opiate during an overdose. Will County Sheriff’s Office first began use of Narcan in 2014 and continues to be instrumental in training area police departments on the use of this life-saving drug (Fabbre, 2015). All police departments are armed with Narcan when they arrive on the scene of a possible heroin overdose. Narcan is a simple and effective life-saving measure for law enforcement officers to carry on duty when responding to a possible opiate overdose. Further efforts are being pursued to provide assistance to survivors of drug overdoses.
Evaluating the impact of naloxone dispensation at public health vending machines in Clark County, Nevada
Published in Annals of Medicine, 2022
Sean T. Allen, Allison O’Rourke, Jessica. A. Johnson, Chelsi Cheatom, Ying Zhang, Brandon Delise, Kellie Watkins, Kathleen Reich, Rick Reich, Cassius Lockett
In response to the ongoing overdose crisis, communities have implemented an array of overdose prevention initiatives, including: increasing access to evidence-based drug treatment, implementing quick response teams that aim to link persons who recently overdosed to substance use treatment and harm reduction services, passing Good Samaritan laws that encourage persons to seek help during overdose emergencies, and offering fentanyl test strips for drug checking. Programs that distribute the overdose reversal medication naloxone to persons at risk of experiencing or witnessing an overdose have also been implemented and studied among several vulnerable populations [7–15]. Further, a 2016 systematic review found that take-home naloxone program utilisation was associated with reductions in overdose mortality rates [16]. There is also no evidence of naloxone access encouraging or enabling substance use [14, 17–20]. While existing efforts to prevent overdose should not be discounted, sustained escalations in overdose fatalities underscore the need for innovations in how communities approach overdose prevention.
Related Knowledge Centers
- Intramuscular Injection
- Ligand
- Nasal Spray
- Receptor Antagonist
- Tachycardia
- Opioid
- Medication
- Opioid Overdose
- Intravenous Therapy
- Opioid Withdrawal