Emergency Medical Minute1 Mar 2022

Podcast 760: Why Fentanyl is the Worst

Contributor: Don Stader, MD

Educational Pearls:

Fentanyl's common administration route through pills has lowered the psychological barrier of using opioid compared to injecting and smoking heroin
Fentanyl is showing up in all illicit drugs with documented cases even in marijuana
Testing for fentanyl is difficult and requires a send out test because UA does not show up not common in ED but can better inform our care
Fentanyl doesn't show up on UA drug screen and requires a send out test, thus we should ask patients if they're using fentanyl specifically
Send any patient using an illicit drug home with Narcan to protect them from potential opioid overdoses
Start patients on buprenorphine for opioid withdrawal in the ED
Fentanyl is very lipophilic, thus patients require longer washout times (sometimes over 24 hours) before buprenorphine induction to avoid precipitated withdrawal

References:

Adams, K.K., Machnicz, M. & Sobieraj, D.M. Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: a systematic review. Addict Sci Clin Pract 16, 36 (2021). https://doi.org/10.1186/s13722-021-00244-8

Moustaqim-Barrette, A., Dhillon, D., Ng, J. et al. Take-home naloxone programs for suspected opioid overdose in community settings: a scoping umbrella review. BMC Public Health 21, 597 (2021). https://doi.org/10.1186/s12889-021-10497-2

*Image from NIDA

Summarized by Mason Tuttle

Denne episoden er hentet fra en åpen RSS-feed og er ikke publisert av Podme. Den kan derfor inneholde annonser.

Episoder(1169)

Podcast 1014: Eating and Drinking on Shift

Contributor; Aaron Lessen, MD Educational Pearls: A 2026 survey asked Canadian emergency medicine (EM) physicians about their eating and drinking habits while on shift. Among 527 respondents, 35%...

27 Jul 2min

Podcast 1013: Thoracotomy Indications

Contributor; Taylor Lynch, MD Educational Pearls: Thoracotomy Thoracotomy is used in traumatic cardiac arrest to replace conventional CPR with direct access to the chest. Goals include identif...

20 Jul 3min

Podcast 1012: Meth Sedation

Contributor: Aaron Lessen, MD Educational Pearls: Agitated patients who are intoxicated with methamphetamine pose a unique challenge when selecting a sedative to counter their symptoms. Is there ...

13 Jul 1min

Podcast 1011: Creepy Crawlies

Contributor: Meghan Hurley, MD Educational Pearls: What animal is the most lethal to humans? Depending on how we define lethal, and animal, this answer is actually not straight forward. Globall...

6 Jul 7min

Podcast 1010: First Pass Intubation Success

Contributor: Travis Barlock, MD Educational Pearls: First-pass success is critical to limit complications from apnea, hypoxia, and airway trauma. Complication rate for patients intubated on the f...

29 Jun 3min

On the Streets- Zero to Rodeo

Dan Orbidan, OMS-II and Dr. Travis Barlock, MD discuss a real out of hospital call. This episode covers the implications of a pharmacologically abnormal patient presentation and the pre and post hospi...

22 Jun 35min

Carepoint Journal Club- Neurology

Carepoint Journal Club is a quarterly series with discussions about a medical topic, brought to you by Carepoint's Emergency Physicians.

15 Jun 36min

Podcast 1009: Prevention for Recurrent UTI

Contributor: Aaron Lessen, MD Educational Pearls: UTIs are commonly seen in older women We often see them taking long-term prophylactic antibiotics because of common recurrence. Around 20-30% of...

8 Jun 1min