Opioids Work on CNS and can depress CNS function 5 Work on CNS and can depress CNS function Available in oral, transmucocal, sublingual, inhalation and injectable forms Eg: sublingual morphine, oral hydrocodone transmucosal fentanyl Require prescription and authorization Caution: Depresses respiratory drive Opioids can cause GI upset. Be sure that the side effects are acceptable. Side effects include constipation, slow reaction time, drowsiness, ataxia, GI upset, respiratory depression. Caution: there are many opioid/NSAID and opioid/APAP combinations like Vicodin and Percocet. Taking an NSAID or APAP/paracetamol in addition may lead to overdose of the non-opioid medication. Have become common causes for ODs, especially accidental because they i.e. heroin is mixed with more potent drugs like fentanyl.

Naloxone Temporarily displaces opioids from receptors 5 Temporarily displaces opioids from receptors Administration – IN. IM, IV Dosage – 1mg; may need to repeat Administer 1 – 2 mg depending on the device. May repeat as needed Reversal can last up to 2 hrs and as short as 30 min Some of the synthetic opioids (e.g., fentanyl, carfentanil my be more resistant to naloxone. You likely won’t know they are mixed in Withdrawal symptoms can be provoked – agitation, sweats, tachcardia, N/V, seizures

Suspected Overdose Treatment 5 Unresponsive; no or ineffective breathing Suspect opioid use or no other apparent cause Administer naloxone; repeat Treat what you find Be prepared for withdrawal symptoms Protect airway and ventilate as needed Recreational use of opioids is more prevelant in populations that are served by our graduates = rural communities, remote worksites, recreational and educational environments

Circulatory Respiratory Primary Assessment 4 Stabilize the Patient Circulatory Respiratory Nervous Pulse Bleeding Airway Breathing Primary Assessment Note the sub heading: stabilize the patient; or the mantra “find it, fix it, fast”. The three parts of the primary assessment focus on the function of the three critical systems. give examples: control of severe bleeding, airway obstruction, hole in the chest, etc. Level of consciousness should be noted during the primary assessment, but specific treatment of any changes may be delayed until the rest of the assessment is completed. Ensuring spine protection does not always require hands-on stabilization if the patient is not moving around or at risk for falling over. Simply asking the patient not to move their head is usually sufficient. * AVPU Spine “The initial assessment is your quick-check on the status of the patient's three critical body systems.”

Respiratory Failure Low Risk High Risk Respiratory Distress: 4 Respiratory Distress: Difficulty breathing, speaks in short sentences. A on AVPU, anxious Respiratory Failure: Able to speak only one or two words at a time. A, lethargic to V, or P on AVPU Respiratory Arrest: No breathing These distinctions are focused on effort and mental state and are not dependent on RR. Any could have a high, low or normal respiratory rate. Respiratory distress is a high risk problem. It will lead to failure and arrest if not corrected. Respiratory failure will rapidly progress to respiratory arrest. Respiratory failure is an invitation to immediate action. The diagnostic distinction between respiratory distress and respiratory failure has practical application in the field. Respiratory distress is difficulty breathing where the brain is still receiving enough oxygen to function more or less normally. A patient may be able to tolerate respiratory distress for a while, but respiratory distress that cannot be fixed will inevitably progress to respiratory failure. How quickly this occurs will depend on the patient and the condition. Respiratory failure is when the system can no longer oxygenate well enough to maintain brain function. The obvious sign is altered mental status and level of consciousness. Respiratory arrest may take the form of completely ineffective effort like “agonal respiration”, where little or no air is being moved. Low Risk High Risk

Brain Failure Mechanisms: S – Sugar T – Temperature O – Oxygen 3 Mechanisms: S – Sugar T – Temperature O – Oxygen P – Pressure E – Electricity A – Altitude T – Toxins S – Salts The STOPEATS acronym covers most of the causes of impaired brain function. Altitude and Pressure may be redundant since HACE is increased ICP. Oxygen refers to hypoxia – suffocation or oxygen deprivation secondary to drowning, CO poisoning, etc. Pressure refers to increased intracranial pressure or to problems with perfusion pressure (shock). Electricity could be lightning or man-made current. E can also include epilepsy. Altitude refers mostly to the cerebral component of altitude illness: AMS and mild and severe HACE. Toxins; alcohol, recreational drugs, poisons, gas like carbon monoxide, or the result of sepsis or multi organ failure. Salts; hyponatremia. Photo: Al Hickey; on the ice. “The numerous causes of impaired brain function can be summarized … with the mnemonic STOPEATS.” *

Toxins - Generic Treatment 3 TIME limit absorption enhance elimination metabolize excrete 1. Basic Life Support; treat what you see. 2. Remove and dilute - MOI specific. 3. Evacuate - ALS Intercept as needed. 4. Antidote or antivenom? Too much time can be wasted trying to figure out what the toxin is. Best to first stabilize patient and begin evacuation if there is an existing or anticipated critical system problem. *