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.

Episoder(389)

Ep 212 PECARN Febrile Young Infant Prediction Tool: When To Safely Forgo LP and Empiric Antibiotics

Ep 212 PECARN Febrile Young Infant Prediction Tool: When To Safely Forgo LP and Empiric Antibiotics

If you’ve been practicing EM for more than a decade, your approach to the febrile young infant has (appropriately) evolved. For years, the default was LP + empiric antibiotics + admission for almost e...

27 Jan 47min

EM Quick Hits 70 MedMal Cases Upper Back Pain, Traumatic Pneumothorax/Hemothorax Decision Making, Risk Stratification of ICH for Consultation, Post-Circumcision Bleeds, IV Contrast Allergy, Emotional Contagion

EM Quick Hits 70 MedMal Cases Upper Back Pain, Traumatic Pneumothorax/Hemothorax Decision Making, Risk Stratification of ICH for Consultation, Post-Circumcision Bleeds, IV Contrast Allergy, Emotional Contagion

In this month's EM Quick Hits podcast: Mike Weinstock discusses with Anton a case of upper back pain in this month's Medmal Cases, Andrew Petrosoniak on traumatic pneumothorax and hemothorax decision ...

13 Jan 1h 6min

Ep 211 Thyrotoxicosis and Thyroid Storm: Recognition and Management

Ep 211 Thyrotoxicosis and Thyroid Storm: Recognition and Management

In this Part 2 of our 2-part podcast series on thyroid emergencies Anton, Dr. George Willis and Dr. Alyssa Louis answer questions such as: When a patient presents with “sepsis without a source,” what ...

30 Des 20251h 13min

Ep 210 Decompensated Hypothyroidism Recognition and Management

Ep 210 Decompensated Hypothyroidism Recognition and Management

In the ED, we regularly care for sick patients presenting acutely with abnormal vital signs, altered mental status, and end organ dysfunction. Oftentimes, the culprit ends up being sepsis, or overdose...

16 Des 20251h 12min

EM Quick Hits 69 Pediatric Urinary Retention & Acute Transverse Myelitis, Post-Dural Puncture Headache, Med Mal Cases: Clenched Fist Injury, IV Thrombolysis for Minor Stroke, EM Leadership Spotlight #4

EM Quick Hits 69 Pediatric Urinary Retention & Acute Transverse Myelitis, Post-Dural Puncture Headache, Med Mal Cases: Clenched Fist Injury, IV Thrombolysis for Minor Stroke, EM Leadership Spotlight #4

On this month's EM Quick Hits podcast: Deborah Schonfeld on the differential diagnosis and work up of pediatric urinary retention & acute transverse myelitis, Jesse McLaren on his Tryptic Approach to ...

2 Des 20251h 32min

Ep 209 Nondisabling Stroke Recognition and Management

Ep 209 Nondisabling Stroke Recognition and Management

In this Part 2 or our 2-part podcast update on ED stroke management with Dr. Katie Lin and Dr. Walter Himmel we explore non-disabling strokes, where symptoms are mild enough that patients can continue...

11 Nov 20251h 19min

Ep 208 Paradigm Shift in Ischemic Stroke Management Part 1: Disabling Strokes

Ep 208 Paradigm Shift in Ischemic Stroke Management Part 1: Disabling Strokes

We are amidst a paradigm shift in the emergency management of acute ischemic stroke. The traditional way of categorizing ischemic strokes as 'minor' vs 'major' is no longer relevant to what we do in t...

28 Okt 20251h 36min

EM Quick Hits 68 Osteomyelitis, Tourniquet Technique, Pediatric Distal Radius Buckle Fractures, DSI RCT, AMS in ESRD & Dialysis, EM Leadership Spotlight #3

EM Quick Hits 68 Osteomyelitis, Tourniquet Technique, Pediatric Distal Radius Buckle Fractures, DSI RCT, AMS in ESRD & Dialysis, EM Leadership Spotlight #3

On this month's EM Quick Hits podcast: Dr. Isaac Bogoch on recognition and management of osteomyelitis in the ED, Dr. Anand Swaminathan on tourniquet tips and tricks. Dr. Andrew Tagg on managing pedia...

7 Okt 20251h 25min

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