Dr. Aaron Orkin’s PP Feb 2016

Dr. Orkin delivered to Canadian Emergency Care Conference Toronto Feb 19, 2016

Dr. Orkin is also co-author this malfeasance ‘Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.’ CJPH 2013;104(3)e200-4 http://journal.cpha.ca/index.php/cjph/article/view/3788
My response
https://jgarythompson.wordpress.com/2016/08/12/response-cjph-20131043e200-4-2/

My response to power point https://aliascpr.wordpress.com/2016/02/26/dr-a-orkin-overdose-training-and-naloxone-distribution/

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(fine print hyperlink) ‘Guidelines Update: the Science of Changing Lives’   http://3mg34c37ntii24dmio2yy6o5.wpengine.netdna-cdn.com/wp-content/uploads/2015/10/2015-Guideline-Special-CircumstancesUpdate-Infographic1.pdf

Quote #5 “Trained providers should administer naloxone to respiratory arrest patients with suspected opioid overdose”  Response:  Laypersons must follow standard medical practice to any respiratory emergency patient.  Humankind has known since the invent of opium 5,500 years ago, overdose death you stop breathing.  Per all medicine supply respiratory assist essential (rescue breathing) to all respiratory emergency patients.

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Slide 5a (see fine print hyperlink)   Overdose: Worse than the road toll  http://www.cdc.gov/vitalsigns

Small print hyperlink http://www.overdoseday.com/wp-content/uploads/2013/07/Factsheet-Greater-than-the-Road-Toll-KE-FINAL-15-August-2013.pdf

Quote p.1 “Non-fatal overdose, where someone has stopped breathing, can lead to hypoxic brain injury, caused by a lack of oxygen to the brain.  These brain injuries can cause coma, seizures and, in worst case scenarios, brain death.  The long-term consequences of hypoxia depend on how long the brain is starved of oxygen. In severe cases, brain injuries from overdoses can leave people in a vegetative state.”

Response: Rescue breathing essential to stop the above complications that happen to every respiratory emergency patient.  Opioid overdose is a respiratory emergency, not a cardiac arrest until brain dead lack of oxygen.  Chest compression’s only is just going to make sure you stay dead

Note link to  Drug Free www.drugfree.org   Response: My opinion “dysfunctional civilization a cause of drug use and abuse”

 

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Slide 6a Response: That is an x-ray of pulmonary edema, under ventilate any respiratory emergency patient pulmonary edema can kill you days later.  The second slide same page perpetuating fear of HIV/AIDS??  The coughing picture does that represent someone’s who’s alveoli sacs have been ruptured (pulmonary edema) and now the patient is spewing blood and pus??
http://www.radiologyassistant.nl/en/p50d95b0ab4b90/chest-x-ray-lung-disease.html

HIV/AIDS Response: Anyone with a compromised immune system that suffers any respiratory emergency and does not receive prompt rescue breathing, the pre existing condition is compounded.  Does this slide perpetuate fear??

Slide page 6b (see fine print) Gomes, Tara et al. “The burden of premature opioid-related mortality.” Addiction 2014;109(9)p.1482-1488
Response: Article has no direct mention cause of death

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Slide 8a
Recognize overdose.
Respond to overdose with:
– BLS  [Basic Life Support rescue breathing italics mine]
– Naloxone

Slide 8b  Walley AY, Xuan Z, Hackman HH, Quinn E, Doe-Simkins M, Sorensen-Alawad A, Ruiz S, Ozonoff A.
Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis.   BMJ. 2013;346:f174    Quote p.1 “providing rescue breathing, and delivering naloxone”

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Slide 9a  Exploring the life-saving potential of Naloxone
NCBI December 2015;(26)12, Pages 1183–1188    Quote p.1184 “because of ethical concerns related to denying control participants access to a life-saving medication” “reverse opioid overdoses when properly trained”  p. 1185 “The content of training interventions was similar across each study and largely comprised of training in recognition, prevention and management of overdose, including life support and naloxone administration
p. 1187 “However using naloxone does not always equate to saving a life as some people may survive without it” “Given the variability of these training characteristics between the studies included in this review we elected not to include any analysis which explored how they might mediate success or not. RCT-level research comparing different THN training structures to determine the most effective delivery methods should be prioritised.”  “Therefore the PoU (proportion of use) should be taken literally, not implied as a proportion of success”

Response: ‘including life support…..’ Rescue breathing  ‘…..some people may survive without it’  People may wake up with rescue breathing before Naloxone administered.

Slide 9b Angela K. Clarke et. al. ‘A Systematic Review of Community Opioid Overdose Prevention and Naloxone Distribution Programs’ Journal of Addiction Medicine January 2014 8(3):153-63

Quote p.153 “Patients that overdose are in a life threatening situation that requires an immediate medical intervention”  “…..respond correctly to witnessed opioid overdose?”  P.155 “…appropriate responses to overdose events, such as contacting emergency medical personnel, instructions on rescue breathing…”

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Slide 10a Rebecca E Giglio, Guohua Li, Charles J DiMaggio ‘Effectiveness of bystander naloxone administration and overdose education programs: a meta-analysis’
http://link.springer.com/article/10.1186%2Fs40621-015-0041-8#/page-1  Quote p.1 ” Naloxone has been the standard treatment for overdose effects like respiratory depression, sedation, and hypotension in the emergency department setting for the past 3.5 decades…”  p. 2 “…overdose response strategies, such as calling 911 or using rescue breathing.”

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Slide 11a  Response: There is no evidence for the use of Naloxone in cardiac arrest situations. Simple logic blood is not moving Naloxone (or any antidote) can’t get to the brain stem.  Dr. Roberts ‘Dissecting the ACLS guidelines cardiac arrest from toxic ingestions’ http://journals.lww.com/em-news/Fulltext/2011/10000/InFocus__Dissecting_the_ACLS_Guidelines_on_Cardiac.7.aspx

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Slide 13  (see fine print) Seal KH, Downing M, Kral AH, Singleton-Banks S, Hammond JP, Lorvick J, Ciccarone D, Edlin BR ‘Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area J. Urb. Health 2003 Jun 80(2): 291-301
Quote p. 294 “…Standard definition for heroin overdose that consisted of “stopped breathing” and “turning blue” p.297 “…we found the most common response to an overdose was an attempt lay remedies that had little or no physiological basis…”
“…possessing naloxone does not guarantee survival after an overdose because peers might not be able to locate the naloxone, or might fail to use it properly or soon enough.”  p.298 “Even when 911 is called, a short response time of 5 minutes could result in irreversible brain injury..”

Response: As in near drowned 4-7 minutes till sever brain death, heart stops secondary to respiratory arrest.  Chest compressions only has no affect.

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Slide 14b These conditions need rescue breathing also  – Drowning – Anaphylaxis – Choking – Snake Bites – Hypothermia – Cardiac arrest [Chest compressions only is for a sudden witnessed cardiac arrest only]

Quote  Dr. Gordon Ewy World expert on chest compression’s only “Some doctors worry that bystanders can get confused and do only chest compressions in drug-overdose and drowning cases.”
http://www.azcentral.com/news/articles/2010/01/19/20100119cardiacdoc0119.html#ixzz3twj9cUQe

Quote Dr. Orkin “We should prevent overdose rather than treating it.”  Response: Nice inferance ‘don’t treat an overdose’ Case reports women and children Naloxone ineffective kept alive rescue breathing.  Read my comment Marcia L. Buck  ‘Naloxone for the Reversal of Opioid Adverse Effects’ Pediatric Pharmacotherapy 2002;8(8)p.1-5 http://www.medscape.com/viewarticle/441915_4

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Slide 16a Quote “Full CPR Naloxone and AED” Response AED only works for dysrhythmias Ventricular Fibrilation and Ventricular Tachycardia.
Naloxone has no role in the management of cardiac arrest. Simple logic – patient is dead cardiac arrest.  http://journals.lww.com/em-news/Fulltext/2011/10000/InFocus__Dissecting_the_ACLS_Guidelines_on_Cardiac.7.aspx

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Slide 17a Health Canada Statement on Change in Federal Prescription Status of Naloxone http://news.gc.ca/web/article-en.do?nid=1027679
Quote “training would be required for those potentially administering the drug”

Response: Rescue breathing is essential for any of the hundreds of causes of respiratory emergency.

Slide 17b Liberal MP’s bill proposes ‘Good Samaritan’ immunity during overdoses  http://www.cbc.ca/news/politics/mp-drug-overdose-bill-1.3454146
Quote “we need every tool in the toolbox and this is one of those tools that we could use”  “spending much of the rest of your life in a vegetative state”   “come up with some new actions, some new activity, some new interventions.”

Response: Appropriate response essential”  “rescue breathing essential”  “vegetative state severe brain hypoxia lack of oxygen”
“intervention opioid OD has been know for over 5,000 years you stop breathing”

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Slide19a
Anaphylaxis: Epi Pen and support rescue breathing
Asthma: Puffer and support rescue breathing
Choking: unblock airway essential
Overdose: Any poisoning or drug OD is a respiratory failure not sudden cardiac arrest

Slide 19b Above protocol is for a sudden witnessed cardiac arrest. Letter Heart & Stroke Foundation Chest Compression’s only  https://jgarythompson.wordpress.com/2016/07/09/heart-stroke-foundation/

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Slide 20a Quote “No standard first aid strategy”
Response:  All 70+ references from 2015 CPR guidelines on opioid overdose and comments  ALL SAY RESCUE BREATHING NO MENTION ANYWHERE CHEST COMPRESSIONS ONLY
https://aliascpr.wordpress.com/2015/12/13/2015-ilcor-and-aha-references-opioid-od/

END OF POWER POINT

Dr. Aaron Orkin, P. Leece ‘Opioid Overdose Fatality Prevention’ JAMA 2013;309(9)873 Quote “Opioid users deserve the same high-quality, evidence-based practice as other patients.”

My letter Emergency Medicine News Dec. 2015  http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx

Dr. Aaron Orkin co-author  ‘Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.’ Can. J. Public Health 2013;104(3):e200-4 http://journal.cpha.ca/index.php/cjph/article/view/3788

My response to above article https://jgarythompson.wordpress.com/2016/08/12/response-cjph-20131043e200-4-2/

One of my articles the 2015 ILCOR & AHA guidelines  BLS891
http://circ.ahajournals.org/content/132/16_suppl_1/S51.full.pdf+html
BLS 891 https://jgarythompson.wordpress.com/2016/07/06/opioid-overdose-response-education-bls-891/
Such an honour to receive a like on the above post from Dr. Richard Wilmot who spent years doing street outreach in disenfranchised neighbourhoods. Treating physical and mental health issues.   ‘American Euphoria: Saying ‘Know’ to Drugs’ By Richard Wilmot

Letter Heart & Stroke Foundation Chest Compression’s only   https://jgarythompson.wordpress.com/2016/07/09/heart-stroke-foundation/

Harm Reduction Coalition Chest Compression’s only  http://harmreduction.org/wp-content/uploads/2012/02/alert-hands-only-cpr.pdf  Simple logic breathing problem gets rescue breaths only

Canadian Red Cross Chest compression’s only http://www.redcross.ca/training-and-certification/first-aid-tips-and-resources-/first-aid-tips/compression-only-cpr

Dr. Gordon Awy the world expert on chest compression’s only.  He phoned me “Gary don’t stop what you are doing”
Quote “Some doctors worry that bystanders can get confused and do only chest compressions in drug-overdose and drowning cases [any asphixia or poisoning etc].”
http://www.azcentral.com/news/articles/2010/01/19/20100119cardiacdoc0119.html#ixzz3twj9cUQe

AHA 2016 HANDS-ONLY CPR FACT SHEET
http://cpr.heart.org/AHAECC/CPRAndECC/Programs/HandsOnlyCPR/UCM_475604_CPR-Learn-More.jsp   CPR Resources Click 2016 Hands-Only CPR Fact Sheet Word

Public Health can’t even read the instructions from the manufacture of Naloxone Hydrochloride Monograph http://www.drugs.com/monograph/naloxone-hydrochloride.html
“Administration should be accompanied by other resuscitive measures such as administration of oxygen, mechanical ventilation, or artificial respiration.”

Dec 28 2015 Metro News http://www.metronews.ca/news/toronto/2015/12/27/harm-reduction-partnership-irks-community.html   “So much of this is perceptions rather than the truth,” Thompson said

Toronto Star Jan 17, 2016 http://www.thestar.com/opinion/editorials/2016/01/17/fast-track-this-life-saving-antidote-editorial.html  Quote “These drugs kill by shutting down a victim’s breathing”

Alberta Feb 2, 2016 http://globalnews.ca/news/2493651/29-alberta-clinics-now-offer-naloxone-kits-for-fentanyl-overdose-treatment/ Quote “teaches mouth-to-mouth breathing and how to administer naloxone”

Letters from Public Health etc. and medical consensus https://jgarythompson.wordpress.com/

Don’t Forget to Breathe @GaryCPR

St. John Ambulance current edition.  Hundreds of causes of respiratory emergency all require respiratory assist (rescue breathing) breathing emergency is not a cardiac arrest.

ST John

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