Higher naloxone dosing may be required for opioid overdose

2019 ◽  
Vol 76 (22) ◽  
pp. 1835-1837 ◽  
Author(s):  
Russell Bardsley
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
New Hampshire ◽  
Community Hospital ◽  
High Dose ◽  
Opioid Overdose ◽  
Small Community ◽  
Emergency Personnel ◽  
High Doses ◽  
Small Community Hospital

Abstract Purpose Carfentanil is a synthetic opioid with an estimated potency that is 10,000 times more than that of morphine and 100 times more than that of fentanyl. Although there is a paucity of evidence, when considering the potency of carfentanil, it is reasonable to speculate that larger doses of naloxone may be required to resuscitate patients after carfentanil ingestion. This case report discusses the use of high-dose naloxone in 2 patients with suspected carfentanil overdose presenting to a small community hospital. Summary Two patients with suspected carfentanil overdose presented to a 30-bed emergency department at a community hospital in New Hampshire. Cyanosis and respiratory distress were noted in both instances, and airway intervention was ultimately deemed necessary. Patient 1 required a total of 12 mg of naloxone to be successfully resuscitated, while patient 2 required a total of 10 mg for resuscitation. Both patients were successfully resuscitated with high doses of naloxone. The use of high-dose naloxone prevented the need for intubation in these patients. Conclusion While more robust studies should be considered, emergency personnel should be comfortable using higher-than-standard doses of naloxone in appropriate cases.

Speed and accuracy of text-messaging emergency department electrocardiograms from a small community hospital to a provincial referral center

2015 ◽  
Vol 22 (2) ◽  
pp. 105-113 ◽  
Author(s):  
Frank Xavier Scheuermeyer ◽  
Brian E Grunau ◽  
Timothy Findlay ◽  
Eric Grafstein ◽  
Jim Christenson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Text Messaging ◽  
Community Hospital ◽  
Small Community ◽  
Referral Center ◽  
Speed And Accuracy ◽  
Small Community Hospital

scholarly journals Quantifying prescribed high dose opioids in the community and risk of overdose

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joe Schofield ◽  
Deborah Steven ◽  
Rebecca Foster ◽  
Catriona Matheson ◽  
Alexander Baldacchino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Service Improvement ◽  
High Dose ◽  
Opioid Overdose ◽  
Opioid Prescribing ◽  
Patient Level ◽  
Strong Opioid ◽  
High Doses ◽  
Strong Opioids ◽  
Very High

Abstract Background Opioid prescribing for a range of health issues is increasing globally. The risk of fatal and non-fatal overdose is increased among people prescribed strong opioids: in high doses in the context of polypharmacy (the use of multiple medications at the same time), especially with other sedatives; and among people with multiple morbidities including cardiorespiratory, hepatic and renal conditions. This study described and quantified the prescribing of strong opioids, comorbidities and other overdose risk factors among those prescribed strong opioids, and factors associated with high/very high opioid dosage in a regional health authority in Scotland as part of a wider service improvement exercise. Methods Participating practices ran searches to identify patients prescribed strong opioids and their characteristics, polypharmacy, and other overdose risk factors. Data were anonymised before being analysed at practice and patient-level. Morphine Equivalent Doses were calculated for patients based on drug/dose information and classed as Low/Medium/High/Very High. Descriptive statistics were generated on the strong opioid patient population and overdose risk factors. The relationship between the prescribing of strong opioids and practice/patient-level factors was investigated using linear and logistic regression models. Results Eighty-five percent (46/54) of GP practices participated. 12.4% (42,382/341,240) of individuals in participating practices were prescribed opioids and, of these, one third (14,079/42,382) were prescribed strong opioids. The most common comorbidities and overdose risk factors among strong opioid recipients were pain (67.2%), cardiovascular disease (43.2%), and mental health problems (39.3%). There was a positive significant relationship between level of social deprivation among practice caseload and level of strong opioid prescribing (p < 0.001). People prescribed strong opioids tended to be older (mean 59.7 years) and female (8638, 61.4%) and, among a subset of patients, age, gender and opioid drug class were significantly associated with prescribing of High/Very High doses. Conclusions Our findings have identified a large population at potential risk of prescription opioid overdose. There is a need to explore pragmatic models of tailored interventions which may reduce the risk of overdose within this group and clinical practice may need to be tightened to minimise overdose risk for individuals prescribed high dose opioids.

Indications for Tonsillectomy in Infectious Mononucleosis

PEDIATRICS ◽  
1971 ◽  
Vol 48 (2) ◽  
pp. 338-339
Author(s):  
Edward J. Feroli ◽  
Gordon W. Mella ◽  
Frank A. Pedreira ◽  
Regis T. Storch ◽  
Howard P. Gutgesell
Keyword(s):  
Case Report ◽  
Infectious Mononucleosis ◽  
Community Hospital ◽  
Nasotracheal Intubation ◽  
Benign Disease ◽  
Therapeutic Modality ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Acute Airway Obstruction ◽  
Dose Corticosteroid

We read with interest the recent report, "Acute Airway Obstruction in Infectious Mononucleosis."1 Dr. Gutgesell appropriately has called attention to a serious complication of a usually benign disease. He mentions brief, high-dose corticosteroid therapy, tracheotomy, nasotracheal intubation, and IPPB as potential modes of therapy. The following case report suggests an additional therapeutic modality in the management of these patients. A 4-year-old girl was admitted to a community hospital in acute respiratory distress associated with suspected infectious mononucleosis.

scholarly journals Efficacy of a Mentoring Program on Nurse Retention and Transition Into Practice

2018 ◽  
Vol 3 (2) ◽  
pp. 31
Author(s):  
Jacquelyn D. Szalmasagi
Keyword(s):  
Community Hospital ◽  
Retention Rates ◽  
Mentoring Program ◽  
Mentor Program ◽  
Small Community ◽  
Graduate Nurses ◽  
New Graduate Nurses ◽  
New Graduate ◽  
Transition Into Practice ◽  
Small Community Hospital

Background: The United States and countries around the world are often faced with a nursing shortage. Studies indicate the reasons for the shortages include low job satisfaction and other factors leading to decreased retention rates.Purpose: The purpose of this study was to determine if participating in a mentor program impacted the transition into practice and retention rates of new graduate nurses at a small community hospital in northern Indiana.Method: This was a retrospective, descriptive, quasi-experimental study. A total of 20 new graduate nurses were studied to determine whether participation in a mentoring program had any impact on their retention at the facility. The participants who completed the mentoring program were asked to complete a questionnaire which examined their perception of the correlation between their completion of the program and their transition into practice.Results: This study determined that participating in a mentor program impacted the transition into practice and retention rates of new graduate nurses at a small community hospital in northern Indiana. The questionnaire results indicated that participation in the mentoring program helped with the new graduate nurses’ transition into practice. This study was guided by Benner’s novice to expert theory.

No Implementation Without Representation: Real-Time Pharmacist Intervention Optimizes Rapid Diagnostic Tests for Bacteremia at a Small Community Hospital

2021 ◽  
pp. 001857872110375
Author(s):  
Brandon J. Tritle ◽  
Robert Watteyne ◽  
Abby Hickman ◽  
Todd J. Vento ◽  
Bert K. Lopansri ◽  
...  
Keyword(s):  
Real Time ◽  
Diagnostic Tests ◽  
Community Hospital ◽  
Statistical Significance ◽  
Pharmacist Intervention ◽  
Rapid Diagnostic Tests ◽  
Control Group ◽  
Small Community ◽  
The Impact ◽  
Small Community Hospital

Background: Rapid diagnostic tests (RDTs) for bacteremia allow for early antimicrobial therapy modification based on organism and resistance gene identification. Studies suggest patient outcomes are optimized when infectious disease (ID)-trained antimicrobial stewardship personnel intervene on RDT results. However, data are limited regarding RDT implementation at small community hospitals, which often lack access to on-site ID clinicians. Methods: This study evaluated the impact of RDTs with and without real-time pharmacist intervention (RTPI) at a small community hospital with local pharmacist training and asynchronous support from a remote ID Telehealth pharmacist. Time to targeted therapy (TTT) in patients with bacteremia was compared retrospectively across 3 different time periods: a control without RDT, RDT-only, and RDT with RTPI. Results: Median TTT was significantly faster in both the RDT with RTPI and RDT-only groups compared with the control group (2 vs 25 vs 51 hours respectively; P < .001). TTT was numerically faster for RDT with RTPI compared with RDT-only but did not reach statistical significance ( P = .078). Median time to any de-escalation was significantly shorter for RDT with RTPI compared with both RDT-only (14 vs 33 hours; P = .012) and the control group (14 vs 45 hours; P < .001). Median length of stay was also significantly shorter in both RDT groups compared with the control group (4.0 vs 4.1 vs 5.5 hours; P = .013). Conclusion: This study supports RDT use for bacteremia in a small community hospital with ID Telehealth support, suggesting additional benefit with RTPI.

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