Eventbrite free OD training June 8 thru Aug 31 2017 Public Health is still teaching how to increase morbidity and mortality to anyone with any breathing emergency. Get your tickets above hyperlink, capacity 1,250 people no Naloxone being given out but attendees will tell all their friends all the signs of breathing emergency, then give chest compression’s.
Ten’s of thousands in Ontario, Canada taught all the signs of breathing emergency drug OD then trained to give chest compression’s only. Empower laypersons what they think is a life saving technique they are eagerly following a clinicians instructions increasing morbidity and mortality any breathing emergency patient. Increases mental and physical illness drug use and abuse, dysfunctional society. Loss of trust in the medical profession, addictions councilors and harm reduction. Grade school science ‘How the Heart and Lungs work”
Just simple logic suffer any of the HUNDREDS OF CAUSES BREATHING EMERGENCY?
A) Rescue Breaths
B) Chest Compression’s
THINK, ITS A VERY HARD QUESTION
Information package I gave all participants June 8 training including case reports
Start of Power Point ‘Opioid Overdose Education, Prevention and response’ created by Toronto Public Health. My notes in red
Sick Kids home of the Ontario Poison Centre http://www.sickkids.ca/AboutSickKids/Newsroom/Past-News/2007/50000-Ontarians-are-poisoned-each-year-according-to-the-Ontario-Poison-Centre.html
Ontario Poison Centre ‘Street Opioid Resuscitation Recommendations’ For Pre-Hospital and Hospital Care http://www.ontariopoisoncentre.ca/pdf/72759-Hopsitalguidelines_naloxone_v2.pdf
Quote Ontario Poison Centre
“For the non-responsive patient with a pulse, but NOT BREATHING
1. Attempt to stimulate respirations.
2. Assist respirations using Bag-Valve-Mask set-up [rescue breaths for layperson italics mine]
3. If no response to respiratory stimulation, administer naloxone 0.4 mg IV/IM
4. IF NO RESPONSE in 3 minutes, administer naloxone 2 mg IV/IM
5. IF NO RESPONSE in a further 3 minutes, administer naloxone 4 mg IV/IM
6. Anticipate doubling the dose until a cumulative dose of 12 mg has been given. If still no response, intubation and ventilation will be required [continuous rescue breathing pre hospital and when admitted italics mine]
7. Some fentanyl analogues have longer half-lives than that of fentanyl or heroin. Repeated dosing of naloxone may be necessary. As usual, an intravenous infusion of naloxone at 2/3 wake-up dose per hour, can be initiated and titrated based on patient response
8. The patient must be monitored:
a. For at least 6 hours after the last dose of naloxone AND
b. Vital signs have returned to baseline vitals AND
c. Normal GCS AND
d. At least 24 hours after the initial overdose
9. Call the OPC for further recommendations.
For the PATIENT IN CARDIAC ARREST suspected to be as a result of an opioid overdose. [patient most likely brain dead (oxygen deprivation), prognosis very poor. It’s not a simple cardiac arrest from heart disease italics mine]
1. For EMS providers: Follow local EMS protocols and “patching” procedures
2. Start compressions, bag-valve-mask ventilations and follow usual ACLS protocols for the pulseless victim
3. Once good resuscitative measures are in place, administer naloxone 2 mg IM/IV
4. Anticipate the need for increasing doses of naloxone; naloxone dosing can be doubled every 3 minutes if no response, to a maximum of 12mg. Continue usual ACLS protocols
5. Call OPC for further recommendations
Naloxone video Toronto Harm Reduction ‘NALOXONE: Saves lives, learn how, share the knowledge’ Read comment box Darryl Gebien MD quote “What I think Alias CPR is getting at, is that “rescue breaths” are not being taught in this and other opioid overdose scenarios. Lack of breathing (apnea) is the main issue in severe OD and occurs before cardiac arrest, so the correct treatment is to ventilate the patient and give compression’s if no heartbeat/pulse present. Health care professionals are taught (ACLS) to do so in opioid OD, but for some reason the public (bystanders, BLS protocol) is not.” D. Gebien MD, MSc, ABEM https://youtu.be/zlbkU5IK5Do
Darryl Gebien MD written, sung and recorded dedicated to his Mother who passed Fentanyl OD ‘The Air I Breathe’
RN in above video incident BMJ ‘Doc2Doc’ “Every worked with a psychopath”
From page 8 large poster taped to wall
Jan 9, 2017 Toronto’s Mayor John Tory and Barbara Yaffe MD quoted “Ventilation’s (rescue breathing) most important” Chest compression’s only still being taught!! Read comment box YouTube https://youtu.be/oelj408VmBU
Mayors quotes at 37 minutes “When you have a CRISIS…one thing that often stands in the way…different protocols people have…that they have protocols that are well agreed upon…this person didn’t tell me that…we have a different system here…this is what causes people to lose their lives quite literally.” Mayor is pissed anyone with any breathing emergency is being murdered, you or you family may be next.
My letter ‘Flaws in Toronto’s Opioid Overdose Prevention Program’ EMN 2015; 37(12):31 With hyperlinks to Public Health Ontario’s training literature, and also the proper protocol.
BREATHS per all medicine anything less is gross negligence for any breathing emergency Dr. Nicholas Etches Medical Officer of Health
EMS rescue breathing until Naloxone takes affect and patient breaths adequately on their own.
Ontario Pharmacist Association ‘How to kill your own Grandma & Mother her own child’ https://youtu.be/1a_SRu82jlw
Case report Jake at 7:25 minutes. 4 breaths/min BVM = (rescue breathing ESSENTIAL) then Naloxone. Continue rescue breaths mandatory until next slide 14 breaths/min oxygen level 97% https://youtu.be/aZ2SPcHUsvA
Lange ‘Poisoning and drug OD‘ see page 1 ad fin item https://murdercube.com/files/Chemistry/Poisoning%20and%20Drug%20Overdose%20(4th%20Edition).pdf
Lange newer edition http://accessmedicine.mhmedical.com/content.aspx?bookid=391§ionid=42069814
2010 American Heart Association Guidelines Part 12:7 Toxic Ingestion’s http://circ.ahajournals.org/content/122/18_suppl_3/S829.full#sec-80 Quote AHA “ventilation should be assisted by a bag mask [rescue breaths layperson italics mine] followed by administration of naloxone and placement of an advanced airway [continue breaths layperson italics mine] if there is no response to naloxone .
“Practically every sign and symptom observed in drug overdose can be produced by natural disease, and many clinical presentations associated with natural disease can be mimicked by some poison.“
Response: Any of the hundreds of causes respiratory emergency mimic an overdose, rescue breaths ASAP. 2015 AHA guidelines refer you to the 2010 guidelines, suggest everyone follow what 2010 says.
My moderated comments 2015 AHA & ILCOR guidelines ‘Opioid Overdose Response Education’ with hyperlinks Ontario Public Health protocols in comment box https://youtu.be/PX0HQuaNS_I
All 70+++ references from 2015 AHA & ILCOR guidelines on opioid overdose quotes ‘rescue breathing only’
INCHEM.org Quote “it is extremely important to give oxygen and to support ventilation immediately while waiting for naloxone to be available for injection.”
2015 European Resuscitation Council Guidelines for Resuscitation
Section 4. ‘Toxins’ p.165
Quotes “fewer adverse events when airway opening, oxygen administration and ventilation are carried out before giving naloxone” “Large opioid overdoses may require a total dose of up to 10 mg of naloxone” “In respiratory arrest there is good evidence for the use of naloxone, but not for any other adjuncts or changes in interventions.”
Goldfrank’s ‘Toxicologic Emergencies’ p.566 etc.
Quotes “The consequential effects of acute opioid poisoning are CNS and respiratory depression. Although early support of ventilation and oxygenation is generally sufficient to prevent death, prolonged use of bag-valve-mask ventilation and endotracheal intubation may be avoided by cautious administration of an opioid antagonist.” “Differentiating acute opioid poisoning from other etiologies with similar clinical presentations may be challenging.” [previous means doctors have trouble diagnosing one respiratory emergency from another]
Heart & Stroke Foundation Official site read the only moderated my comment AliasCPR https://youtu.be/Wy3eEES511E
Letter from H & S Foundation which was CC’d to Dr. Laruie Morrison and Shawn Hopkins Manager ‘The Works’ http://www.slideshare.net/GaryThompson11/heart-and-stroke-foundation-letter
My response posted in ‘Rogue Medic’ aka Tim Noonan 30 years EMS “We keep making excuses for solutions that are neat, plausible, and wrong. Why don’t we start acting like responsible medical professionals and do what is best for our patients?”
Thank you to Gary Thompson of Agnotology for linking to this for me. https://aliascpr.wordpress.com/2017/01/24/cpr-k-p-mcdonald-ems/
Medscape ‘Naloxone for the Reversal of Opioid Adverse Effects’ http://www.medscape.com/viewarticle/441915_4
First line quote “All patients considered to have opioid intoxication should have a stable airway and adequate ventilation established before the administration of naloxone.”
My peer reviewed comment above article
Complications chest compression’s a drastic measure only to be preformed cardiac arrest, chest compression’s only secondary to respiratory arrest contraindicated.
Atcheson SG, Fred HL. ‘Letter: Complications of cardiac resuscitation’ Am Heart J. 1975 Feb;89 (2):263-5 http://www.slideshare.net/GaryThompson11/complications-chest-compressions-64269212
Your pet eats a poison or drug Veterinarian will give respiratory assist and any antidote, not torture them with chest compression’s only. Why would we allow this to our women and children?
It’s a mental illness called Anosognosia a severe form of denial. Anosognosia is quite different than simple or temporary denial. It is not simply denial of a problem, but the genuine inability to recognize that the problem exists. Usually this is caused by brain damage and/or FEAR!
Agnotology is the study of culturally induced ignorance or doubt, particularly the publication of inaccurate or misleading scientific [medical] data. Agnotology focuses on the deliberate fomenting of ignorance or doubt in society.
Not placing blame, change this protocol for the well being of all. Stop needless suffering Google @GaryCPR more info