In part 2, Dr Sheyna Gifford will discuss the how to differentiate opioid overdose from other causes of altered mental status, some special disposition situations (especially with methadone), and how we can quickly screen for opioid abuse and provide patients compassionate care, treatment, and referral.
Opioids in the ED part 2 with Dr. Sheyna Gifford
Opioids Combined Show Notes (PDF)
My standard opioid prescription speech for all patients:
I am prescribing you a strong pain medication called Norco (or Percocet, respectively- aka hydrocodone or oxycodone). This medication can make you sleepy so don’t drive or drink alcohol when you are taking it because it can be very harmful if you do. This medication also has Tylenol (acetaminophen) in it so don’t mix it with anything else that has Tylenol in it. Some people are having problems with these medications by becoming addicted to them. To avoid this, I want you to only take this medication when your pain is so bad that you cannot function. This may not take away all your pain- it will just take the edge off so you can function. I want you to take it for as short of an amount of time as possible- if you only need this pain medication for 2 or 3 days and you have leftover pills, I want you to throw out your pills in the trash. Don’t save them for another time and don’t give them to anyone else. Please keep them locked up and away from the reach of children, teens, or anyone else who has issues with addiction.
Please visit our bandwidth sponsor EB Medicine. Residents and attendings can both get special offers from EB Medicine by visiting the EM Basic page.
It’s no secret that we have a major opioid problem in the United States. The number of people addicted to opioids has reached epidemic proportions and we are certainly seeing this everyday in the Emergency Department. In this episode Dr. Sheyna Gifford discusses a few facts about the scope of this epidemic, the basics of recognizing opioid overdose, and initial stabilization and treatment. She’ll discuss the many different ways of using naloxone (aka Narcan) that we can utilize to wake up patients safely and without precipitating acute withdrawal.
Opioids Part 1 with Dr. Sheyna Gifford
Opioids Part 1 Show Notes (PDF)
Check out our bandwidth sponsor EB Medicine. Residents can get free access and attendings can get a discount at the EB Medicine EM Basic page.
This is just a quick note to say that EM Basic will be back and better than ever in the New Year. As of January 2017, it will be almost a year since I have published an episode and that is going to change just after the New Year. With the help of some collaborators, I have been able to record a number of episodes in advance so I can release episodes on a more regular basis.
I have a plan to publish two episodes per month for the rest of 2017 and I have already recorded ahead a number of episodes to make that happen. They are all set to publish in the next few months. That’s why those of you who have an email subscription to the website accidentally got an email today with February’s topics- whoops!
A big thank you to all the contributors who have been patient in seeing their work published on the podcast. Since this is mostly a one-person operation, my time has been limited with my transition out of the military and into my new job. This is all on me and I appreciate everyone’s patience.
Stay tuned for another announcement on how providers of all levels and training can get involved in helping to make EM Basic an even better resource.
The first episodes right after the New Year will publish on Monday January 2nd with a two part review on Opioids in the ED, followed by hypothermia, then a three part screencast to review orthopedic injuries just before the inservice exam.
Until next time- Stay Classy,
EM Basic is back with a re-broadcast from the awesome podcast Pediatric Emergency Playbook by Dr. Tim Horeczko. Tim is a double boarded in EM and Peds EM and works at Harbor-UCLA hospital. This was the first episode he published at the beginning of September and it is pure gold. Tim goes beyond the febrile neonate and talks about how to consider all possible causes for a sick infant- not just anchoring on sepsis the whole time! Tim presents a rational and systematic approach on how to deal with these young sick patients that get our anxiety and our adrenaline levels through the roof.
The undifferentiated sick infant by Dr. Tim Horeczko podcast
The Undifferentiated Sick Infant by Dr. Tim Horeczko Show Notes (Word Format)
The Undifferentiated Sick Infant by Dr. Tim Horeczko (PDF)
Check out our bandwidth sponsor, EB Medicine. Residents can get free access and attendings can get a great discount on their CME products
EB Medicine EM Basic page
This is part 2 of the Heme Onc Emergencies series. This episode will talk about common hematology emergencies that we see in the ED. Sickle cell disease will be its own episode but this episode will talk about the approach to anemia in the ED, as well as the approach to hemophilias, ITP and TTP. While you will see lots of anemic patients in the ED, the other diseases are rare but we have to be on the look out for them and know what to do.
Heme Onc Part 2- Hematology Emergencies
Heme Onc Part 2 Show Notes (Word Format)
Heme Onc Part 2 Show Notes (PDF)
Check out the EM Basic page on EB Medicine for free access for residents and discounts for attendings. The September issue of Pediatric EM Practice discusses Hemophilia and von Willebrand disease in kids.
Factor Replacement Formula
Factor 8- (Target factor activity level – Baseline factor activity level) / (2 x pt weight in kilograms)
Factor 9- (Target factor activity level – Baseline factor activity level) / (pt weight in kilograms)