Podcast 760: Why Fentanyl is the Worst

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

Avsnitt(1148)

Podcast 871: Increased Intracranial Pressure and the Cushing Reflex

Podcast 871: Increased Intracranial Pressure and the Cushing Reflex

Contributor: Travis Barlock MD Education Pearls: The Cushing Reflex is a physiologic response to elevated intracranial pressure (ICP) Cushing's Triad: widened pulse pressure (systolic hypertensio...

2 Okt 20233min

On The Streets #15: Hydrofluoric Acid Case Review

On The Streets #15: Hydrofluoric Acid Case Review

Contributors: Kalen Abbott, MD - EM Physician and Medical Director for AirLife Denver Brendan Reiss - Flight Nurse AirLife Denver Matt Spoon - Flight Paramedic AirLife Denver Jordan Ourada - E...

29 Sep 202341min

Episode 870: Advanced Trauma Life Support (ATLS)

Episode 870: Advanced Trauma Life Support (ATLS)

Contributor: Meghan Hurley MD Educational Pearls: What is ATLS? Advanced Trauma Life Support (ATLS) is a systematic and comprehensive approach to the evaluation and management of trauma patients I...

25 Sep 20237min

Podcast 869: Shift Work

Podcast 869: Shift Work

Contributor: Meghan Hurley MD Educational Pearls: Shift work is defined as anything that takes place outside of a 9-5 schedule, not exempting day-shift medical workers Various ill effects of shift...

18 Sep 20234min

Episode 868: Airway Management in Obesity

Episode 868: Airway Management in Obesity

Contributor: Aaron Lessen MD Educational Pearls: Why is airway management more difficult in obesity? Larger body habitus causes the chest to be above the head when the patient is lying supine, creat...

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Episode 867: Occult Scaphoid Fractures

Episode 867: Occult Scaphoid Fractures

Contributor: Nick Tsipis MD Educational Pearls: The scaphoid bone is the most proximal carpal bone just distal to the radius Fractures of the scaphoid bone are sometimes missed by plain X-rays ...

4 Sep 20234min

Podcast 866: Carbamazepine (Tegretol) Overdose

Podcast 866: Carbamazepine (Tegretol) Overdose

Contributor: Aaron Lessen MD Educational Pearls: What is Carbamazepine (Tegretol)? Carbamazepine is an anti-epileptic drug with mood-stabilizing properties that is used to treat bipolar disorder, ep...

28 Aug 20232min

Laboring Under Pressure- Episode 1. ACLS in Pregnancy with Dr. Jason Papazian

Laboring Under Pressure- Episode 1. ACLS in Pregnancy with Dr. Jason Papazian

Contributor: Jason Papazian MD, Travis Barlock MD, Jeffrey Olson Summary: In this episode, Dr. Travis Barlock and Jeffrey Olson meet in the studio to discuss several clips from Dr. Jason Papazian's ta...

24 Aug 202332min

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