EMS World

FEB 2019

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.

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Page 40 of 53

EMSWORLD.com | FEBRUARY 2019 39 cyanotic, unconscious, and in imminent risk of hypoxic brain injur y and death. The titratable solutions are mentioned only as another option to utilize in appropri- ate circumstances. Respirator y suppor t remains essential and should be opti- mized during these inter ventions, t ypi- cally with positioning of the air way a s well as bag-valve mask. Once naloxone is administered to an opioid overdose patient who is unrespon- sive, cyanotic, and with little or no respira- tor y effort, the effects are dramatic. The patient awakens from near-death, typi- cally in less than a minute. They may be argumentative or combative, as you have taken away their opioid euphoria and sub- stituted opioid withdrawal. They usually do not appreciate that this recent episode may have been their last. This lifesaving inter vention is commonly per formed in the prehospital arena, and the patient is frequently ready to argue for discharge upon arrival at the emergency depar t- ment. This is an opportunity to implement your best negotiating skills to convince the patient of the need for additional evaluation and obser vation. Outcomes of Transport Refusals The dif ficult question facing the para- medic is to decide when their patient ha s the autonomy to refuse care. It is almost always impossible to quantif y with certainty the amount or type of opi- oid involved and thus have an idea of the duration of the toxicity. The question now is, will the patient's administered dose of opiates (which may be a slow-release formulation or longer-acting variety) out- la st the naloxone, causing a repeat of the respirator y compromise? Are there comorbidities involved, such as trauma, rhabdomyolysis, sepsis, a spiration, or pulmonar y edema? A few studies have evaluated the out- comes of patients who refused transport to the hospital after revival with naloxone, but the compilation of follow-up data for these patients is problematic. Since the opioid abuser frequently uses the substance illegally, the use of assumed n a m e s i s c o m m o n . Tr a c k i n g t h e s e patients down after their initial encoun- ters is thus dif ficult. The studies do not specifically quantif y the dose or type of opioid consumed, so no dis tinc tion is made bet ween methadone, morphine, POTENTIAL COMORBIDITIES • Trauma • Infection • Rhabdomyolysis • Aspiration • Pulmonary edema • Psychiatric • Gastrointestinal bleeding • Acute kidney injury • Concomitant toxicologic ingestion (evident/suspected) Specializing in Pediatric Medical Solutions We are a medical device company dedicated to providing high-quality equipment and turn-key solutions to the EMS market. When it comes to pediatric patient moving and handling, our products support all aspects of immobilization, patient transportation and first aid services – these are vital elements when treating and rescuing critically injured infants and children. Provides for the safe and effective transport of infants and children in an ambulance, covering weight ranges from 4lbs to 99lbs. CALL ONE OF OUR EXPERTS NOW ON 516.321.9494 ACR-4 AMBULANCE CHILD RESTRAINT 2 in 1 - full size backboard with insert for pediatric /child transport board for optimized space and performance. 3 Combo full body pediatric /vacuum splint set which minimizes body movement compared to spinal backboards. PEDIATRIC VACUUM MATTRESS PEDIATRIC SPINAL BOARD Post childbirth harness which provides close proximity safety during mother and baby transportation. AEGIS THE SEATBELT OF MATERNITY 3000 Marcus Avenue, Suite 3E6, Lake Success, NY 11042-1012 T: 516.321.9494 E: sales@quantum-ems.com W: www.quantum-ems.com

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