Treatment of Opioid Overdose - Pt. 2

Get the lesson outline here: www.miglabs.com/opioids
Part 2 of this lesson covers the treatment of opioid overdoses. Many prehospital providers have the same burning questions - What exactly is an opioid? Which drugs are and aren't opioids, again? Can it be bad to give naloxone to a patient who isn't on opioids? Can you give too much naloxone?
Treating an opioid overdose can actually be very simple once you understand what's going on inside the body. Join us as we talk about how opioids work, how antagonists work, and how to safely and effectively treat a patient with an opioid overdose.
Music:
That Sunny Day by Kronicle - / that-sunny-day
Green by X I X X - / green

[@Latin23Boy]

I can’t thank you enough for this videos. I’m a combat medic and I enjoyed and learned a lot from them.

[@diegogarcia-yr6oz]

This is the most in-depth video I've seen so far on naloxone and opioid overdoses. Thanks for sharing this buddy! It's honestly helping me with my research project.

[@Miglabs]

Thanks! Glad that you liked it and found it helpful.

[@diegogarcia-yr6oz]

@@Miglabs Can you send me your resources/studies that you used for this video? I'm required to show both the positive and negative effects of naloxone and your sources would greatly benefit my research. Thanks again!

[@Miglabs]

@@diegogarcia-yr6oz You can get a complete lesson outline, including references, on the MIG Labs website: miglabs.com/opioids/ Good luck with your project!

[@mr.x1363]

Tooo good 👍.. liked and subscribed 👍

[@lewisr00]

Great video - thanks. Do you have any sense as to why naloxone is the dominant treatment not naltrexone?

[@freddiespinoza]

Excelent!.

[@tanmaygajbhiye6203]

Thnx ❣️

[@Miglabs]

Happy to help!

[@mra1385]

Another great video. I had a question about the negative effects of naloxone that you mentioned, including ARDS. Would these occur only in opioid overdose patients who are given too much nalaxone (and so are these just the severe withdrawal symptoms?) or could these also occur in patients who have NOT had any opioids or an opioids OD. What is the impact of nalaxone on patients who have not taken any opioids? Is it harmless in those circumstances? I ask because many jurisdictions use nalaxone as a diagnostic, as you mention in video 1, but I'm not sure if the negative effects would impact non opioid OD patients. Also, what dosage level are we talking about here? Is it near the 2 ml dose or does it take significantly more than that to trigger the severe withdrawal symptoms that you describe? Thanks!!

[@Miglabs]

Hi Michael, Glad you enjoyed the video! Great questions. Because naloxone is an *inverse agonist* and not an *antagonist*, it can cause opioid withdrawal symptoms in any patient - even patients who do not have or have never had any opioids in their system. In fact, because a patient without any opioids is at the 0% mark on the "opioid effect scale", they're more likely to suffer from withdrawal symptoms at lower doses. The exact dose that it takes to put someone in to withdrawal is pretty variable, which is why most sources recommend titrating naloxone in relatively small increments. The practice of using naloxone as a diagnostic tool is widespread. At small doses, it may be acceptable, but "giving large doses of antagonist to establish the diagnosis of opioid poisoning is usually not helpful and potentially dangerous, and therefore not recommended" [1]. In the video, we recommend giving naloxone in increments of 0.05 mg/dose for bradypneic patients, and 0.2-1 mg/dose for apneic patients, with about 1 minute between doses. Using this titration strategy is much safer than "slamming" a whole pre-filled syringe of 2 mg all at once. As you're titrating, you should be seeing a response. If you've given a few doses and you're not seeing any response, you should consider that maybe the patient isn't overdosing on opioids, and in fact has some other cause for their symptoms. Hope this helps! References: 1. Stolbach A, Hoffman RS. Acute opioid intoxication in adults. In: Traub SJ, Grayzel J, eds. UpToDate.; 2016.

[@mra1385]

Thanks. I think the idea that non-opioid users can experience the same withdrawal symptoms as opioid users is something that isn't widely realized at the EMT level (and maybe the paramedic level).