Best Case Ever 41 Opiate Misuse and Physician Compassion

Best Case Ever 41 Opiate Misuse and Physician Compassion

Opiate misuse is everywhere. Approximately 15-20% of ED patients in the US are prescribed outpatient opiates upon discharge. In Ontario, about 10 people die accidentally from prescription opiates every week. Between 1990 and 2010, drug overdose deaths in the US increased by almost four fold, eclipsing the rate of death from motor vehicle collisions in 2009. This was driven by deaths related to prescription opiates, which now kill more people than heroin and cocaine combined. Opiates are the most prescribed class of medication in the US. In 2010, one out of every eight deaths among persons aged 25 to 34 years was opiate-related. Four out of 5 new heroin users report that their initial drug was a prescription opiate. In Ontario, three times the people died from opiate overdose than from HIV in 2011. Yet, we are expected to treat pain aggressively in the ED. Dr. Reuben Strayer, the brains behind the fantastic blog EM Updates tells his Best Case Ever, in which he realizes the importance of physician compassion in approaching the challenging drug seekers and malingerers that we manage in the ED on a regular basis. This Best Case Ever is in anticipation of an upcoming main episode in which Dr. Strayer and toxicologist Dr. David Juurlink discuss how to strike a balance between managing pain effectively and providing the seed for perpetuating a drug addiction or feeding a pre-existing drug addiction, and how we best take care of our patients who we suspect might have a drug misuse problem.

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EM Quick Hits 65 Occipital Nerve Block, PoCUS in Pulmonary Embolism, Myelopathy, Team Resuscitation, Incidental Neutropenia, Peer Programs

EM Quick Hits 65 Occipital Nerve Block, PoCUS in Pulmonary Embolism, Myelopathy, Team Resuscitation, Incidental Neutropenia, Peer Programs

On this month's EM Quick Hits podcast: Dr. Mathew MacArther on Occipital Nerve Block, Dr. Ian Chernoff on PoCUS in Pulmonary Embolism, Dr. Hans Rosenberg on Myelopathy, Dr. Shawn Segeren on Team Resus...

3 Kesä 20251h 8min

Ep 204 High Risk Pulmonary Embolism Management

Ep 204 High Risk Pulmonary Embolism Management

There are many nuances in the management of patients with pulmonary embolism in cardiac arrest, peri-arrest or simply in shock: We need to optimize oxygenation and airway management, hemodynamic suppo...

13 Touko 20251h 24min

EM Quick Hits 64 Whole Blood Transfusions, Calcium Before Diltiazem in Afib, Thoracotomy Pearls, Uterine Casts, OMI Scale & Proportionality

EM Quick Hits 64 Whole Blood Transfusions, Calcium Before Diltiazem in Afib, Thoracotomy Pearls, Uterine Casts, OMI Scale & Proportionality

In this month's EM Quick Hits podcast: Zafar Qasim & Andrew Petrosoniak on whole blood transfusion in trauma, Justin Morgenstern on calcium pre-treatment to prevent diltiazem-induced hypotension, Kira...

21 Huhti 20251h 1min

Ep 203 Intermediate Risk Pulmonary Embolism Risk Stratification, Management and Algorithm

Ep 203 Intermediate Risk Pulmonary Embolism Risk Stratification, Management and Algorithm

How do you predict which intermediate-risk patients will suddenly deteriorate? What role do risk scores, biomarkers, imaging, and hemodynamics play in decision-making? Should these patients receive an...

1 Huhti 20251h 35min

EM Quick Hits 63 S-TEC and HUS, IM Epinephrine in OHCA, Dengue, Geriatric Trauma Imaging, TTP

EM Quick Hits 63 S-TEC and HUS, IM Epinephrine in OHCA, Dengue, Geriatric Trauma Imaging, TTP

On this month's EM Quick Hits podcast: Stephen Freedman on pediatric bloody diarrhea, S-TEC and hemolytic uremic syndrome, Justin Morgenstern on the evidence for IM epinephrine in out of hospital card...

11 Maalis 20251h 6min

Ep 202 Eating Disorders: Common, Commonly Missed, Mismanaged and Misunderstood

Ep 202 Eating Disorders: Common, Commonly Missed, Mismanaged and Misunderstood

Eating disorders have the highest mortality rate of any psychiatric illness, yet they are frequently missed in the Emergency Department as they can be elusive. Only one in 246 patients who screen posi...

18 Helmi 20251h 27min

EM Quick Hits 62 Optimizing RSI Medication Timing, ED Boarding of Older Patients, Prolonged Tourniquet Use, Rural Peer Support Programs, ECG Reciprocal Changes, Nutrition Tips for Shift Workers

EM Quick Hits 62 Optimizing RSI Medication Timing, ED Boarding of Older Patients, Prolonged Tourniquet Use, Rural Peer Support Programs, ECG Reciprocal Changes, Nutrition Tips for Shift Workers

On this month's EM Quick Hits podcast: Anand Swaminathan on optimizing RSI medication timing, Brittany Ellis on ED boarding challenges in older patients and solutions to ED crowding and flow, Dave Jer...

28 Tammi 20251h 26min

Ep 201 How EM Experts Think Part 2: Data Gathering, Diagnostic and Treatment Decision Making, Test Ordering and Interpretation, Documentation, Emotional Resilience

Ep 201 How EM Experts Think Part 2: Data Gathering, Diagnostic and Treatment Decision Making, Test Ordering and Interpretation, Documentation, Emotional Resilience

In this Part 2 of our 2-part podcast series on How EM Experts Think with Dr. Reuben Strayer, Dr. Mike Betzner and Dr. Scott Weingart we dive deep into the nuances of practicing smarter, faster, and be...

7 Tammi 20251h 23min

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