OD training June – Aug 31, 2017

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.

ORIGINAL POWER POINT which was given to all Board of Health members, my June 12, deputation  read comment box hyperlinks

June8NO NALOXONE

Dr. Eric Hoskins sociopath https://youtu.be/jkBTyAqvzqI  Medical info hyperlinked

THRA minutes June 9

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

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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

 

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Annotated medical info ‘Naloxone’ and my moderated comments 14-15 Then follow trackback for more of my moderated comments http://roguemedic.com/?s=Naloxone

Read my 7 moderated comments Tim Noonan 30 years EMS blog http://roguemedic.com/2015/02/proposed-2015-acls-chest-compression-only-cpr-vs-conventional-cpr-recommendation/

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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”

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From page 8 large poster taped to wall

June 8 Large POSTER

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.
http://www.citynews.ca/2017/01/09/officials-meet-in-toronto-to-tackle-fentanyl-issues/

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.
http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx

BREATHS per all medicine anything less is gross negligence for any breathing emergency Dr. Nicholas Etches Medical Officer of Health
http://www.cbc.ca/player/play/895066691568/

EMS rescue breathing until Naloxone takes affect and patient breaths adequately on their own.

Ontario Ministry of Health murderous protocol https://www.linkedin.com/pulse/ministry-health-od-protocol-gary-thompson

50,000 Ontarians are poisoned each year 28,000 children http://www.sickkids.ca/AboutSickKids/Newsroom/Past-News/2007/50000-Ontarians-are-poisoned-each-year-according-to-the-Ontario-Poison-Centre.html

15,000 out of hospital cardiac arrests per year Ontario https://www.ices.on.ca/Newsroom/News-Releases/2014/Survival-rates-improving-for-out-of-hospital-cardiac-arrest-patients

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&sectionid=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 .
Toxidromes
“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’
https://aliascpr.wordpress.com/2015/12/13/2015-ilcor-and-aha-references-opioid-od/

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
https://cprguidelines.eu/sites/573c777f5e61585a053d7ba5/content_entry573c77e35e61585a053d7baf/573c78115e61585a053d7bce/files/S0300-9572_15_00329-9_main.pdf
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.
http://freepages.school-alumni.rootsweb.ancestry.com/~dpok/Goldfrank%E2%80%99s%20Toxicologic%20Emergencies%209th%20Edition.pdf
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]

Annotated medical info ‘Naloxone’ and my moderated comments 13-14 Then follow comment 15 for more of my moderated comments http://roguemedic.com/?s=Naloxone

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?”
http://roguemedic.com/2016/12/narcan-by-everyone-does-not-seem-to-be-such-a-good-idea/

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/

Go read Response: ‘What happens when drugs become too powerful for overdose kits’ https://aliascpr.wordpress.com/2016/12/20/response-what-happens-when-drugs-become-too-powerful-for-overdose-kits/

Doctors increasing PTSD in EMS etc and no one says a word?
https://medicalmiscreants.com/2017/01/23/two-more-doctor-drug-pushers-locked-up-some-things-just-never-change/comment-page-1/#comment-55315

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

Live human study training layperson’s all the signs of opioid overdose, then telling them to give chest compression’s only http://journal.cpha.ca/index.php/cjph/article/view/3788

My response to AHA & ILCOR Opioid overdose response education plus Public Health’s training literature.  https://youtu.be/PX0HQuaNS_I

Response to Emily Oliver (awaiting AHA moderator) “….use of naloxone into their education programs. More research is needed regarding educational effectiveness…”

Do we need more research on opioid poisoning resuscitation protocols? Clinicians see opioid poisoning daily in a clinical situation. Terminally ill are kept “comfortable” to wit OD narcotics. Cause of death acute respiratory failure.

Michael Parkinson with Dan Bigg of Chicago Recovery Alliance on OD it’s not rocket science https://www.youtube.com/watch?v=7MYKYScL8L8

Rescue breathing first line defense Naloxone is second line defense
Above original video at 8 minutes https://www.youtube.com/watch?v=RcPB2Ybpyd8

Michael Parkinson of Waterloo Region Crime Prevention Council video Original ‘Eyes Wide Open’ https://www.youtube.com/watch?v=znjKdfYRCGc

“My childhood friend was completely blue…. Started with chest compression’s didn’t seem to have any real great effect”
Correct Joe you are quickening Wades death or anyone else with a breathing emergency, Wade’s heart was beating needed breaths ASAP.
Have talked in person with Joe. Sadly Wade pasted summer 2015

European Resuscitation Council Guidelines for Resuscitation 2010 Section 8.b Poisoning http://resuscitation-guidelines.articleinmotion.com/article/S0300-9572(10)00441-7/aim/

Naloxone left elsewhere http://www.harmreductionjournal.com/content/6/1/26

Quote “most participants did not carry the naloxone with them consistently and consequently it was generally not available if they witnessed an overdose.”
Other studies report same 20% > of the time Naloxone left elsewhere.  Probably means chest compression’s only used in Ontario?

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

Read my six moderated comments
http://roguemedic.com/2015/02/proposed-2015-acls-chest-compression-only-cpr-vs-conventional-cpr-recommendation/

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

 

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