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(1149)

Podcast 859: Teamwork Really Makes the Dream Work

Podcast 859: Teamwork Really Makes the Dream Work

Contributor: Aaron Lessen MD Educational Pearls: 33 Medical residents and 91 nurses at Massachusetts General Hospital were randomized into two groups: Intervention group: 15 PGY-1 residents assig...

10 Juli 20232min

Podcast 858: Whole Blood Pregnancy Test

Podcast 858: Whole Blood Pregnancy Test

Contributor: Meghan Hurley MD Educational Pearls: What do you do if you need a stat pregnancy test on an incapacitated patient? You can send a serum quantitative human chorionic gonadotropin (beta-H...

3 Juli 20234min

Podcast 857: Alice in Wonderland Jeopardy

Podcast 857: Alice in Wonderland Jeopardy

Contributor: Chris Holmes MD Educational Pearls: "It's a poor sort of memory that only works backwards" - Transient Global Amnesia A syndrome with sudden retrograde memory loss in which patients ...

26 Juni 20233min

Podcast 856: ED Errors and Counterstudy

Podcast 856: ED Errors and Counterstudy

Contributor: Nicholas Tsipis, MD Educational Pearls: What study was Dr. Tsipis talking about? In December of 2022, the Agency for Healthcare Research and Quality (AHRQ) put out a study titled "Diagn...

19 Juni 20234min

Podcast 855: QT Intervals

Podcast 855: QT Intervals

​​Contributor: Travis Barlock MD Educational Pearls The QT interval represents phases 2 and 3 of ventricular plateau and repolarization, respectively. As the QT interval lengthens, more sodium an...

12 Juni 20234min

Mental Health Monthly #16: Psychosis in the ED Part II

Mental Health Monthly #16: Psychosis in the ED Part II

Contributors: Andrew White MD & Travis Barlock MD In this follow-up episode Dr. Andrew White, a practicing psychiatrist with an addiction medicine fellowship, and Dr. Travis Barlock, an emergency phys...

7 Juni 202324min

Episode 854: Tranq (xylazine) with Heroin

Episode 854: Tranq (xylazine) with Heroin

Contributor: Aaron Lessen, MD Educational Pearls: What is Tranq? Tranq is the street name for xylazine, a sedative drug typically used in veterinary medicine. Xylazine has recently emerged as a re...

5 Juni 20232min

Podcast 853: Critical Care Medications - Vasopressors

Podcast 853: Critical Care Medications - Vasopressors

Contributor: Travis Barlock MD Educational Pearls: Three categories of pressors: inopressors, pure vasoconstrictors, and inodilators Inopressors:  Epinephrine - nonselective beta- and alpha-adr...

29 Maj 20235min

Populärt inom Vetenskap

dumma-manniskor
p3-dystopia
svd-nyhetsartiklar
allt-du-velat-veta
kapitalet-en-podd-om-ekonomi
rss-vetenskapsradion-2
rss-vetenskapsradion
medicinvetarna
det-morka-psyket
rss-ufo-bortom-rimligt-tvivel-2
bildningspodden
halsorevolutionen
hacka-livet
sexet
rss-geopodden-2
rss-arkeologi-historia-podden-som-graver-i-vart-kulturlandskap
vetenskapsradion
har-vi-akt-till-mars-an
rss-spraket
matfrihet