EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.
Issue link: https://emsworld.epubxp.com/i/131347
There are two ways to take the CE test that accompanies this article and receive 1 hour of CE credit accredited by CECBEMS: 1. Go online to EMSWorld.com/cetest to download a PDF of the test.The PDF has instructions for completing the test. 2. Or go online to www.rapidce.com to take the test and immediately receive your CE credit. Questions? E-mail editor@EMSWorld.com. | By Scott R. Snyder, BS, NREMT-P Sean M. Kivlehan, MD, MPH, , NREMT-P & Kevin T. Collopy, BA, FP-C, CCEMT-P NREMT-P WEMT , , , Understanding Overdose Opioids are a secret and leading cause of death Bob and Jerry, both EMTs, are dispatched to a reported unconscious person at a rural residential address about two miles from their station. They hear the ALS fly car, staffed by their paramedic friend Linda, also sent to the call and realize she is about 10 miles away, across town, and will have a longer response time. They arrive on scene to fnd Mrs. Smith waiting for them at the front door."Please hurry," she says."It's my husband— he's on the couch, and I don't know what's wrong with him." Mr. Smith, a 52-year-old white male, presents supine and unconscious with obviously slow, shallow and snoring breathing and peripheral cyanosis. Bob and Jerry immediately move him to the foor, where Bob moves to the airway while Jerry checks for a pulse. "His radial pulse is about 80 and weak," Jerry reports as Bob suctions a bit of vomit from Mr. Smith's airway."I'm going to start BVM ventilations," Bob responds. "Could you hook the bag up to some oxygen?" Bob measures and inserts an oropharyngeal airway."No gag refex," he observes and begins ventilating Mr. Smith 12 times a minute with the BVM while Jerry sets the oxygen fow rate at 15 lpm. Jerry gets a history of recent events and a past medical history from Mrs. Smith. She says she left about five hours ago to visit a friend. Her husband decided to stay home because he'd hurt his back the day before while doing yard work, was in pain and wanted to rest. Their son, who lives on the next block, came by to visit him as she left. She returned home to find Mr. Smith on the couch, unconscious. Mr. Smith is very healthy without any significant medical history and does not presently take any medications. He has no known drug allergies. A quick physical exam reveals no obvious trauma or any other reason for Mr. Smith's presentation. His pupils are 5 mms, equal and reactive to light. There is no JVD or peripheral edema, and his lung sounds are equal bilaterally with slight rales. There is no response to painful stimuli. "Any ideas?" Bob asks Jerry. "Maybe stroke or hypoglycemia?" Jerry replies. CONTINUING EDUCATION This CE activity is approved by EMS World, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), for 1 CEUs. OBJECTIVES • Review the growing problem of opioid overdose • Discuss clinical presentation of opioid overdose • Review prehospital management of opioid overdose patients EMSWORLD.com | JUNE 2013 57