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(1144)

Episode 950: Ultrasound Pulse Check During Cardiac Arrest

Episode 950: Ultrasound Pulse Check During Cardiac Arrest

Contributor: Aaron Lessen, MD Educational Pearls: Point-of-care ultrasound (POCUS) is used to assess cardiac activity during cardiac arrest and can identify potential reversible causes such as peric...

31 Mars 20252min

Episode 949: Hoover's Sign

Episode 949: Hoover's Sign

Contributor: Travis Barlock, MD Educational Pearls: What is Hoover's sign used to identify? This physical exam maneuver differentiates between organic vs. functional (previously known as psychogenic...

24 Mars 20251min

Episode 948: CYP Inducers and Inhibitors

Episode 948: CYP Inducers and Inhibitors

Contributor: Jorge Chalit-Hernandez, OMS3 Educational Pearls: CYP enzymes are responsible for the metabolism of many medications, drugs, and other substances CYP3A4 is responsible for the majorit...

17 Mars 20253min

Episode 947: Hypercapnia

Episode 947: Hypercapnia

Educational Pearls: Physiologic stimulation of ventilation occurs through changes in levels of: Arterial carbon dioxide (PaCO2) Arterial oxygen (PaO2) Hypercapnia is an elevated level of CO2...

10 Mars 20253min

Episode 946: Time to Defibrillation

Episode 946: Time to Defibrillation

Contributor: Aaron Lessen, MD Educational Pearls: Quick background info Cardiac arrest is when the heart stops pumping blood for any reason. This is different from a heart attack in which the heart ...

3 Mars 20252min

Episode 945: Ketorolac vs. Ibuprofen

Episode 945: Ketorolac vs. Ibuprofen

Contributor: Ricky Dhaliwal, MD Educational Pearls:  Ketorolac and ibuprofen are NSAIDs with equivalent efficacy for pain in the emergency department Oral ibuprofen provides the same relief as in...

24 Feb 20253min

Episode 944: Colchicine Overdose

Episode 944: Colchicine Overdose

Contributor: Aaron Lessen, MD Educational Pearls: Colchicine is most commonly used for the prevention and treatment of gout There is research investigating the anti-inflammatory and cardioprotect...

17 Feb 20253min

Episode 943: Portal Vein Thrombosis

Episode 943: Portal Vein Thrombosis

Contributor: Travis Barlock, MD Educational Pearls: What is Portal Vein Thrombosis? The formation of a blood clot within the portal vein, which carries blood from the gastrointestinal tract, pancrea...

10 Feb 20252min

Populärt inom Vetenskap

p3-dystopia
svd-nyhetsartiklar
pojkmottagningen
dumma-manniskor
allt-du-velat-veta
kapitalet-en-podd-om-ekonomi
det-morka-psyket
rss-vetenskapsradion
rss-experimentet
rss-ufo-bortom-rimligt-tvivel
medicinvetarna
paranormalt-med-caroline-giertz
bildningspodden
rss-vetenskapsradion-2
halsorevolutionen
dumforklarat
vetenskapsradion
hacka-livet
rss-spraket
rss-broccolipodden-en-podcast-som-inte-handlar-om-broccoli