Upload
dinhdung
View
213
Download
0
Embed Size (px)
Citation preview
5/10/2017
1
Produced by the Alabama Department of Public HealthDistance Learning and Telehealth Division
Produced by the Alabama Department of Public HealthDistance Learning and Telehealth Division
ALABAMA ALABAMA LAW ENFORCEMENT LAW ENFORCEMENT
NALOXONENALOXONE TRAININGTRAINING
Provided by:Provided by:
Ann Slattery, DrPH, RN, RPh, DABAT Managing Director
Justin Arnold, DO, MPHMedical Director
Regional Poison Control Center at Children’s of Alabama
University of Alabama at Birmingham Department of Emergency Medicine
Ann Slattery, DrPH, RN, RPh, DABAT Managing Director
Justin Arnold, DO, MPHMedical Director
Regional Poison Control Center at Children’s of Alabama
University of Alabama at Birmingham Department of Emergency Medicine
No DisclosuresConflict of Interest Statement
No DisclosuresConflict of Interest Statement
• This presentation was prepared by
the Regional Poison Control Center
in cooperation with the Alabama
Department of Public Health
• The authors of this presentation have
no conflicts of interest to disclose
• This presentation was prepared by
the Regional Poison Control Center
in cooperation with the Alabama
Department of Public Health
• The authors of this presentation have
no conflicts of interest to disclose
GoalsGoals• Discuss need for naloxone training
• Review 2015 Alabama House Bill 208
• Define and identify opioids
• Recognize signs of an opioid overdose
• Understand how naloxone works
• Learn how to administer naloxone
• Discuss need for naloxone training
• Review 2015 Alabama House Bill 208
• Define and identify opioids
• Recognize signs of an opioid overdose
• Understand how naloxone works
• Learn how to administer naloxone
5/10/2017
2
Why Are We Here Today?Why Are We Here Today?
Opioid Prescriptions Per 100 PeopleOpioid Prescriptions Per 100 People
Why Are We Here Today?Why Are We Here Today?Drug Overdose and Motor Vehicle
Accident DeathsDrug Overdose and Motor Vehicle
Accident Deaths
• Law enforcement officers, firefighters,
and EMTs are increasingly being
called to respond to opioid overdoses
– Law enforcement officers are often
the first responders on the scene
• Timing of the administration of
naloxone and rescue breathing is
critical after an opioid overdose
• Law enforcement officers, firefighters,
and EMTs are increasingly being
called to respond to opioid overdoses
– Law enforcement officers are often
the first responders on the scene
• Timing of the administration of
naloxone and rescue breathing is
critical after an opioid overdose
Why Are We Here Today?Why Are We Here Today? 2015 House Bill 2082015 House Bill 208
• Expanded naloxone use by limiting
liability to prescribers, family and
friends, and permitting law-
enforcement use after training
– Permits law enforcement use of
naloxone (intra-nasal)
– Permits patient assessment
– Permits rescue breathing
• Expanded naloxone use by limiting
liability to prescribers, family and
friends, and permitting law-
enforcement use after training
– Permits law enforcement use of
naloxone (intra-nasal)
– Permits patient assessment
– Permits rescue breathing
5/10/2017
3
What is an Opioid?What is an Opioid?• Opioids are substances that bind to
specific receptors in the brain and decrease
the body’s perception of pain
• Opioids are substances that bind to
specific receptors in the brain and decrease
the body’s perception of pain
• Buprenorphine -Suboxone®
• Codeine - Tylenol #3®
• Fentanyl - Actiq®, Duragesic®, Sublimaze®
• Heroin - 1898-1910
• Hydrocodone - Lorcet®, Norco®, Vicodin®,
Lortab®
• Hydromorphone -Dilaudid®
• Levorphanol - Levo-Dromoran®
• Buprenorphine -Suboxone®
• Codeine - Tylenol #3®
• Fentanyl - Actiq®, Duragesic®, Sublimaze®
• Heroin - 1898-1910
• Hydrocodone - Lorcet®, Norco®, Vicodin®,
Lortab®
• Hydromorphone -Dilaudid®
• Levorphanol - Levo-Dromoran®
• Meperidine - Demerol®
• Methadone - Dolophine®
• Morphine - Roxanol®, Duramorph®
• Opium - Paragoric®
• Oxycodone - Percocet®, Percodan, ® Tylox, ® Oxycontin®
• Oxymorphone - Opana®, Numporphan®, Numorphone®
• Tramadol - Ultram®, Ultracet®
• Meperidine - Demerol®
• Methadone - Dolophine®
• Morphine - Roxanol®, Duramorph®
• Opium - Paragoric®
• Oxycodone - Percocet®, Percodan, ® Tylox, ® Oxycontin®
• Oxymorphone - Opana®, Numporphan®, Numorphone®
• Tramadol - Ultram®, Ultracet®
Generic and Brand NamesGeneric and Brand Names
• Other Pain Medications
• Acetaminophen – Tylenol ®
• Ibuprofen – Motrin ®
• Naproxen - Aleve ®
• Benzodiazepines
• Lorazepam – Ativan ®
• Diazepam – Valium ®
• Alprazolam – Xanax ®
• Muscle Relaxants
• Cyclobenzaprine – Flexaril ®
• Methocarbamol - Robaxin ®
• Other Pain Medications
• Acetaminophen – Tylenol ®
• Ibuprofen – Motrin ®
• Naproxen - Aleve ®
• Benzodiazepines
• Lorazepam – Ativan ®
• Diazepam – Valium ®
• Alprazolam – Xanax ®
• Muscle Relaxants
• Cyclobenzaprine – Flexaril ®
• Methocarbamol - Robaxin ®
• Cocaine
• Methamphetamine
• PCP
• LSD
• Molly / MDMA
• Marijuana
• Cocaine
• Methamphetamine
• PCP
• LSD
• Molly / MDMA
• Marijuana
What is NOT an Opioid?What is NOT an Opioid? Signs of an Opioid OverdoseSigns of an Opioid Overdose“High” versus Overdose“High” versus Overdose
5/10/2017
4
“High” from Opioids“High” from Opioids
• Person will respond to commands
• Breathing appears normal (not
labored or excessively shallow)
• Slow/slurred speech
• Pinpoint pupils (some exceptions)
• Person will respond to commands
• Breathing appears normal (not
labored or excessively shallow)
• Slow/slurred speech
• Pinpoint pupils (some exceptions)
Signs of an Opioid OverdoseSigns of an Opioid Overdose• Depressed mental status
– Unconscious – does not respond to
voice, sternal rub, limp body
• Depressed or absent breathing
– Suppressed breathing < 8
breaths/minute, shallow
– Cyanosis – blue or gray lips or
fingernails
• Depressed mental status
– Unconscious – does not respond to
voice, sternal rub, limp body
• Depressed or absent breathing
– Suppressed breathing < 8
breaths/minute, shallow
– Cyanosis – blue or gray lips or
fingernails
Signs of an Opioid OverdoseSigns of an Opioid Overdose– Pale, clammy skin
– Slow or irregular pulse
– Snoring, gurgling, or choking sounds
(a.k.a. death rattle)
• Pinpoint pupils
– Pale, clammy skin
– Slow or irregular pulse
– Snoring, gurgling, or choking sounds
(a.k.a. death rattle)
• Pinpoint pupils
What is Naloxone?What is Naloxone?
– Generic name for Narcan®
– Rapid opioid reversal agent
– Blocks the effects on the
respiratory control center and
restores respirations
– Blocks the effects on CNS
depression and can restore
alertness
– Generic name for Narcan®
– Rapid opioid reversal agent
– Blocks the effects on the
respiratory control center and
restores respirations
– Blocks the effects on CNS
depression and can restore
alertness
5/10/2017
5
What is Naloxone?What is Naloxone? Naloxone is Only Useful for Opioid Overdoses
Naloxone is Only Useful for Opioid Overdoses
– Naloxone will NOT work to
reverse the effect of any drug or
medication that is not an opioid!
– CPR should be used instead of
naloxone if the individual does
not have have a pulse!
– Naloxone will NOT work to
reverse the effect of any drug or
medication that is not an opioid!
– CPR should be used instead of
naloxone if the individual does
not have have a pulse!
Responding to a Suspected Opioid Overdose EmergencyResponding to a Suspected Opioid Overdose Emergency• Use universal precautions (minimal
level is medical gloves)
• Check for responsiveness and
administer initial rescue breaths if
the person is not breathing
• Request assistance (911)
• Administer naloxone
• Use universal precautions (minimal
level is medical gloves)
• Check for responsiveness and
administer initial rescue breaths if
the person is not breathing
• Request assistance (911)
• Administer naloxone
Responding to a Suspected Opioid Overdose EmergencyResponding to a Suspected Opioid Overdose Emergency• Resume rescue breathing if the
person is not breathing on their
own yet
• Reassess for response and
administer a second dose of
naloxone if no response after 3
minutes
• Resume rescue breathing if the
person is not breathing on their
own yet
• Reassess for response and
administer a second dose of
naloxone if no response after 3
minutes
5/10/2017
6
Intranasal Naloxone Intranasal Naloxone Prepare to Administer Intranasal Naloxone
Prepare to Administer Intranasal Naloxone
NeedlelessNeedlelessSyringeSyringe
MedicationMedicationCapsuleCapsule
MADMAD
Step 1 – Remove Protective Caps
Step 1 – Remove Protective Caps
Step 2 – Attach the Mucosal Atomization Device (MAD)
Step 2 – Attach the Mucosal Atomization Device (MAD)
5/10/2017
7
Step 3 – Gently Screw the Medication Into the SyringeStep 3 – Gently Screw the
Medication Into the SyringeStep 4 – Administer ½ of the Medication Into Each NostrilStep 4 – Administer ½ of the Medication Into Each Nostril
Step 5 – Provide Rescue Breathing if Needed and
Consider Need to Re-dose
Step 5 – Provide Rescue Breathing if Needed and
Consider Need to Re-dose
Alternative Formulationsof Naloxone
Alternative Formulationsof Naloxone
5/10/2017
8
Side EffectsSide Effects• Precipitated opioid withdrawal
– Restlessness, irritability, body aches,
dizziness, weakness, diarrhea,
abdominal pain, nausea, vomiting, fever,
sweating, piloerection (goosebumps),
hypertension and tachycardia
• Allergic Reaction to the medication itself
– Hives, trouble breathing, swelling of
face, lips, tongue or throat
• Precipitated opioid withdrawal
– Restlessness, irritability, body aches,
dizziness, weakness, diarrhea,
abdominal pain, nausea, vomiting, fever,
sweating, piloerection (goosebumps),
hypertension and tachycardia
• Allergic Reaction to the medication itself
– Hives, trouble breathing, swelling of
face, lips, tongue or throat
Frequently Asked QuestionsFrequently Asked Questions• What should I expect once naloxone
has reversed the overdose?
– Improved breathing (goal of naloxone
administration) and possible
withdrawal symptoms
• Can you administer it under the
tongue?
– No, the lining of the mouth is
different than the nose
• What should I expect once naloxone
has reversed the overdose?
– Improved breathing (goal of naloxone
administration) and possible
withdrawal symptoms
• Can you administer it under the
tongue?
– No, the lining of the mouth is
different than the nose
Frequently Asked QuestionsFrequently Asked Questions
• Does it work with a fentanyl patch?
What about the newer fentanyl
analogues?
– Yes, but be prepared to give a
second dose
– Fentanyl (especially a patch)
victims may need multiple
naloxone doses
• Does it work with a fentanyl patch?
What about the newer fentanyl
analogues?
– Yes, but be prepared to give a
second dose
– Fentanyl (especially a patch)
victims may need multiple
naloxone doses
Frequently Asked QuestionsFrequently Asked Questions
• How do you store naloxone?
– It should ideally be stored at room
temperature and away from light
– If stored in a vehicle, store in a
cool place, out of direct sunlight
• How do you store naloxone?
– It should ideally be stored at room
temperature and away from light
– If stored in a vehicle, store in a
cool place, out of direct sunlight