Community management of opioid overdose

World Health Organization relesead the 2014 guidelines for Community management of opioid overdose.

Here are some highlights from the guidelines of particular relevance for emergency medicine

Formulation and dose of naloxone

Route of administration

The GDG recognizes that the IV route is appropriate and effective in medical settings

The capacity of the nasal mucosa to absorb liquids is limited, so if the intranasal route of administration is to be used, concentrated forms of naloxone should ideally be used.

The GDG has made this recommendation fully aware that the intranasal route is currently an off-label (non-licensed) route.

Affordability may dictate the preferred route in particular contexts

Dosage

The choice of initial dose will depend on the formulation of naloxone to be used and the context.

In medical settings dose selection is not generally an issue as dose titration is standard practice. In non-medical settings dose titration is not so easily accomplished and higher initial doses may be desirable.

The context also dictates the total amount of naloxone made available to non-medical responders.

The initial dose should be 0.4mg–2mg, targeting recovery of breathing. In most cases 0.4–0.8 mg is an effective dose. It is important to provide sufficient naloxone to supplement the initial dose, as necessary.

Intranasal delivery may require a higher dose. It should be noted that the commonly used method of intranasal administration is to spray 1 ml of the 1 mg/ml formulation of naloxone into each nostril with an atomizerconnected to a syringe.

Where possible, efforts should be made to tailor the dose to avoid marked opioid withdrawal symptoms. The GDG notes that higher initial doses above 0.8 mg IM/IV/SC are more likely to precipitate significant withdrawal symptoms.

A more complicated situation arises where there has been an overdose of a combination of drugs. In this situation naloxone is still beneficial for reversing the opioid intoxication component of the overdose.

Cardiopulmonary resuscitation

In suspected opioid overdose, first responders should focus on airway management, assisting ventilation and

administering naloxone.

Because the key feature of opioid overdose is respiratory arrest, ventilation is a priority. While recognizing there are different protocols in different parts of the world, the GDG suggests the following steps in resuscitating an individual with suspected opioid overdose.

Apply vigorous stimulation, check and clear airway, and check respiration – look for chest rising and falling.

In the presence of vomit, seizures or irregular breathing, turn the patient on their side, and, if necessary, clear the airway of vomit.

In the absence of regular breathing provide rescue ventilation and administer naloxone.

If there are no signs of life, commence chest compressions.

Re-administer naloxone after two to three minutes if necessary

In all cases call for professional assistance.

Monitor the person until professional help arrives.

Post resuscitative care

After successful resuscitation following the administration of naloxone, the affected person should have their level of consciousness and breathing closely observed until they have fully recovered.

The definition of ‘fully recovered’ is a return to pre-overdose levels of consciousness two hours after the last dose of naloxone.

Ideally, observation should be performed by properly-trained professionals.

The period of observation needed to ensure full recovery is at least two hours, following overdose from short-acting opioids such as heroin. It may be longer where a longer acting opioid has been consumed.

If a person relapses into opioid overdose, further naloxone administration may be required.

The definition of ‘fully recovered’ is a return to pre-overdose levels of consciousness two hours after the last dose of naloxone

Download the full guidelines at

http://apps.who.int/iris/bitstream/10665/137462/1/9789241548816_eng.pdf?ua=1

Tag:oppiates overdose, overdose, toxicology

Commenti Lascia un commento
Categorie Commenti dell'autore, Guidelines update, Linee guida update, Review di letteratura

Rispondi Annulla risposta

Scrivi qui il tuo commento...

Inserisci i tuoi dati qui sotto o clicca su un'icona per effettuare l'accesso:

Email (obbligatorio) (L'indirizzo non verrà pubblicato)

Nome (obbligatorio)

Sito web

Stai commentando usando il tuo account WordPress.com. ( Chiudi sessione / Modifica )

Stai commentando usando il tuo account Google+. ( Chiudi sessione / Modifica )

Stai commentando usando il tuo account Twitter. ( Chiudi sessione / Modifica )

Stai commentando usando il tuo account Facebook. ( Chiudi sessione / Modifica )

Annulla

Connessione a %s...

Follow MEDEST on Twitter

RT @DocSBroderick: So we decided to do something a little different when it came to pre-course reading material for #RESUSCITATE so instead… 5 hours ago
The MEDEST118 Daily is out! paper.li/MEDEST118/1407… Stories via @PoppasPearls @EMJInnovations @juniorsectie #foamed #meded 19 hours ago
New studies on the infinite debate about which is the best strategie for airway management in cardiac arrest. Let's… twitter.com/i/web/status/1… 22 hours ago
The Never Ending Debate. Airway management in cardiac arrest. medest118.com/2018/09/22/the… 22 hours ago
New studies on the infinite debate about which is the best strategie for airway management in cardiac arrest. Let's… twitter.com/i/web/status/1… 22 hours ago

Follow @MEDEST118

Archivi

MyTweet

RT @DocSBroderick: So we decided to do something a little different when it came to pre-course reading material for #RESUSCITATE so instead… 5 hours ago
The MEDEST118 Daily is out! paper.li/MEDEST118/1407… Stories via @PoppasPearls @EMJInnovations @juniorsectie #foamed #meded 19 hours ago
New studies on the infinite debate about which is the best strategie for airway management in cardiac arrest. Let's… twitter.com/i/web/status/1… 22 hours ago
The Never Ending Debate. Airway management in cardiac arrest. medest118.com/2018/09/22/the… 22 hours ago
New studies on the infinite debate about which is the best strategie for airway management in cardiac arrest. Let's… twitter.com/i/web/status/1… 22 hours ago
Yes we are talking about airway management in cardiac arrest. Yes this is another blog post on that topic, and if y… twitter.com/i/web/status/1… 22 hours ago

Follow @MEDEST118

Cerca

Community management of opioid overdose

Formulation and dose of naloxone

Route of administration

Dosage

Cardiopulmonary resuscitation

Post resuscitative care

Download the full guidelines at

http://apps.who.int/iris/bitstream/10665/137462/1/9789241548816_eng.pdf?ua=1

Rispondi Annulla risposta

Follow MEDEST via Email/Segui MEDEST via Email

Follow MEDEST on Facebook

Follow MEDEST on Twitter

Articoli Recenti

The MEDEST on line News

Archivi

MyTweet

Favourites FOAMED Blogs

Scrivi a MEDEST

Cerca

Community management of opioid overdose

Formulation and dose of naloxone

Route of administration

Dosage

Cardiopulmonary resuscitation

Post resuscitative care

Download the full guidelines at

http://apps.who.int/iris/bitstream/10665/137462/1/9789241548816_eng.pdf?ua=1

Condividi:

Mi piace:

Correlati

Rispondi Annulla risposta

Follow MEDEST via Email/Segui MEDEST via Email

Follow MEDEST on Facebook

Follow MEDEST on Twitter

Articoli Recenti

The MEDEST on line News

Archivi

MyTweet

Favourites FOAMED Blogs

Scrivi a MEDEST