Use of Naloxone in 9-1-1 Patients without Respiratory Depression in Los Angeles County, California (USA)

2021 ◽  
Vol 36 (5) ◽  
pp. 543-546
Author(s):  
Colin Jenkins ◽  
Michael Levine ◽  
Stephen Sanko ◽  
Clayton Kazan ◽  
Caroline E. Thomas ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Los Angeles ◽  
Respiratory Rate ◽  
Respiratory Depression ◽  
Los Angeles County ◽  
Medical Service ◽  
A Priori ◽  
Naloxone Administration ◽  
Opioid Deaths ◽  
Cns Depression

AbstractIntroduction:Along with an increase in opioid deaths, there has been a desire to increase the accessibility of naloxone. However, in the absence of respiratory depression, naloxone is unlikely to be beneficial and may be deleterious if it precipitates withdrawal in individuals with central nervous system (CNS) depression due to non-opioid etiologies.Objective:The aim of this study was to evaluate how effective prehospital providers were in administering naloxone.Methods:This is a retrospective study of naloxone administration in two large urban Emergency Medical Service (EMS) systems. The proportion of patients who had a respiratory rate of at least 12 breaths per minute at the time of naloxone administration by prehospital providers was determined.Results:During the two-year study period, 2,580 patients who received naloxone by prehospital providers were identified. The median (interquartile range) respiratory rate prior to naloxone administration was 12 (6-16) breaths per minute. Using an a priori respiratory rate of under 12 breaths per minute to define respiratory depression, only 1,232 (47.8%; 95% CI, 50.3%-54.2%) subjects who received naloxone by prehospital providers had respiratory depression.Conclusion:This study showed that EMS providers in Los Angeles County, California (USA) frequently administered naloxone to individuals without respiratory depression.

Difficulties in Diagnosing Narcotic Overdoses in Hospitalized Paitents

1994 ◽  
Vol 28 (4) ◽  
pp. 446-450 ◽  
Author(s):  
Julianne K. Whipple ◽  
Edward J. Quebbeman ◽  
Kelly S. Lewis ◽  
Mark S. Gottlieb ◽  
Robert K. Ausman
Keyword(s):  
Blood Pressure ◽  
Respiratory Rate ◽  
Respiratory Depression ◽  
Mental Status ◽  
Clinical Presentation ◽  
Case Series ◽  
Hospitalized Patients ◽  
Teaching Hospitals ◽  
Naloxone Administration ◽  
Electrolyte Abnormalities

OBJECTIVE: To describe the clinical presentation of narcotic overdose in hospitalized patients and to differentiate this circumstance from other conditions often misdiagnosed as overdose. DESIGN: Case series. SETTING: Two acute-care teaching hospitals. PATIENTS: Forty-three hospitalized patients who received naloxone for a clinically suspected narcotic overdose. INTERVENTIONS: Two investigators independently evaluated each incident to determine whether the patient had a narcotic overdose. The patients were judged to have had an overdose if caregivers documented an immediate improvementin mental status, respiratory rate, or blood pressure after naloxone administration. MEASUREMENTS: The clinical presentation of a narcotic overdose in hospitalized patients was defined. Conditions misdiagnosed as an overdose were determined. MAIN RESULTS: Symptoms improved rapidly with the administration of naloxone in 28 incidents (65 percent) and were designated overdose. In 15 other instances there was no improvement in symptoms; these patients were designated nonoverdose. Only half of the overdose patients had a respiratory rate <8 breaths/min immediately prior to naloxone administration. Only two of the overdose patients had the classic triad of symptoms (respiratory depression, coma, and pinpoint pupils). Other overdose patients had only one or two of the classic signs. The clinical presentation of narcotic overdoses in hospitalized patients did not include respiratory depression, hypotension, or coma in the majority of patients. All overdose patients showed a decrease in mental status. The majority of nonoverdose patients had pulmonary conditions that were misdiagnosed as a narcotic overdose. CONCLUSIONS: Narcotic overdoses in hospitalized patients seldom fit the classic description. The lack of respiratory depression does not mean the absence of a narcotic overdose. Patients who receive narcotics and develop a signficant decrease in mental status should be evaluated for a possible overdose. Pulmonary, neurologic, cardiovascular, and electrolyte abnormalities often are misdiagnosed as a narcotic overdose in hospitalized patients.

Letter to the Editor

PEDIATRICS ◽  
1974 ◽  
Vol 54 (3) ◽  
pp. 383-384
Author(s):  
Barry H. Rumack ◽  
Phillip Walravens
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Respiratory Depression ◽  
Abstinence Syndrome ◽  
Letter To The Editor ◽  
Central Nervous System Depression ◽  
Chronic Ingestion ◽  
Cns Depression

We must reject Dr. Phillip Nieburg's conjectures as invalid. Central nervous system depression and jitteriness do not correspond well to the ethchlorvynol intoxication syndrome. Patients treated for acute overdosage here, as elsewhere,1-3 demonstrate marked CNS depression, hypothermia, hypertension, hyporeflexia and respiratory depression. This classic syndrome of ethchlorvynol intoxication is not to be confused with the withdrawal syndrome4 of tremors, hallucinations and convulsions. Chronic ingestion of large quantities of ethchlorvynol does not produce toxic features but rather the abstinence syndrome upon termination of the drug.

The Sunland Grizzly

2014 ◽  
Vol 91 (4) ◽  
pp. 56-63
Author(s):  
Josh Sides
Keyword(s):  
Los Angeles ◽  
Los Angeles County ◽  
Southern California ◽  
Grizzly Bear ◽  
Science And Art ◽  
Founding Director

In 1916, Cornelius Birket Johnson, a Los Angeles fruit farmer, killed the last known grizzly bear in Southern California and the second-to last confirmed grizzly bear in the entire state of California. Johnson was neither a sportsman nor a glory hound; he simply hunted down the animal that had been trampling through his orchard for three nights in a row, feasting on his grape harvest and leaving big enough tracks to make him worry for the safety of his wife and two young daughters. That Johnson’s quarry was a grizzly bear made his pastoral life in Big Tujunga Canyon suddenly very complicated. It also precipitated a quagmire involving a violent Scottish taxidermist, a noted California zoologist, Los Angeles museum administrators, and the pioneering mammalogist and Smithsonian curator Clinton Hart Merriam. As Frank S. Daggett, the founding director of the Los Angeles County Museum of History, Science and Art, wrote in the midst of the controversy: “I do not recollect ever meeting a case where scientists, crooks, and laymen were so inextricably mingled.” The extermination of a species, it turned out, could bring out the worst in people.

Unification and Its Discontents

2016 ◽  
Vol 93 (2) ◽  
pp. 4-16
Author(s):  
Brian Kovalesky
Keyword(s):  
Public Schools ◽  
School District ◽  
Los Angeles ◽  
School Districts ◽  
Civil Rights ◽  
Working Class ◽  
Los Angeles County ◽  
The State ◽  
White Working Class ◽  
City Schools

In the late 1950s and early 1960s, during the height of protests and actions by civil rights activists around de facto school segregation in the Los Angeles area, the residents of a group of small cities just southeast of the City of Los Angeles fought to break away from the Los Angeles City Schools and create a new, independent school district—one that would help preserve racially segregated schools in the area. The “Four Cities” coalition was comprised of residents of the majority white, working-class cities of Vernon, Maywood, Huntington Park, and Bell—all of which had joined the Los Angeles City Schools in the 1920s and 1930s rather than continue to operate local districts. The coalition later expanded to include residents of the cities of South Gate, Cudahy, and some unincorporated areas of Los Angeles County, although Vernon was eventually excluded. The Four Cities coalition petitioned for the new district in response to a planned merger of the Los Angeles City Schools—until this time comprised of separate elementary and high school districts—into the Los Angeles Unified School District (LAUSD). The coalition's strategy was to utilize a provision of the district unification process that allowed citizens to petition for reconfiguration or redrawing of boundaries. Unification was encouraged by the California State Board of Education and legislature in order to combine the administrative functions of separate primary and secondary school districts—the dominant model up to this time—to better serve the state's rapidly growing population of children and their educational needs, and was being deliberated in communities across the state and throughout Los Angeles County. The debates at the time over school district unification in the Greater Los Angeles area, like the one over the Four Cities proposal, were inextricably tied to larger issues, such as taxation, control of community institutions, the size and role of state and county government, and racial segregation. At the same time that civil rights activists in the area and the state government alike were articulating a vision of public schools that was more inclusive and demanded larger-scale, consolidated administration, the unification process reveals an often-overlooked grassroots activism among residents of the majority white, working-class cities surrounding Los Angeles that put forward a vision of exclusionary, smaller-scale school districts based on notions of local control and what they termed “community identity.”

Measles in a Patient with Presumed Immunity — Los Angeles County, 2015

2015 ◽  
Vol 64 (39) ◽  
pp. 1123 ◽  
Author(s):  
Amanda Kamali ◽  
Chhandasi P. Bagchi ◽  
Emmanuel Mendoza ◽  
Dulmini Wilson ◽  
Benjamin Schwartz ◽  
...  
Keyword(s):  
Los Angeles ◽  
Los Angeles County
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