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Workshop: Help BL create an Overdose Resource Sticky

I've already learned something from just these notes! I had no idea the snoring could be such an indicator of something being wrong! Not exactly sure what to do if someone who has been hitting h pretty hard seems fine, falls asleep very quickly - then snores like mad. I stayed awake, having done far less and watched him for 8 hrs of what I thought to be him 'sleeping it off'. I could see he was breathing and occasionally restless in his sleep, and as he had ran out the day before and was committed not to getting anymore I truly thought sleeping it off at that point was the best thing. Can someone please tell what the SAFEST and optimal way of handling this situation would have been? My friend and myself as well both have a bit of a record and are very careful of calling in help in drug related situations but of course we would do this in a situation that was threatening eachother's life! On the other hand, there is always that nagging thought of doing it unneceassarily - and bringing more trouble down upon one another. I know better safe then sorry, but it does get to be a tedious situation:?
 
nsa, englandgz and felonious, thank you so much for the work you have done so far. I took what englandz wrote up and put it in a more succinct format as suggested by neversickanymore. Maybe we can use this general layout and add or subtract from it as we go. I think that we could have several things going at once. First, the most important is the very short and concise "What to do". But along with that we could have educational resources for how to perform CPR for example (I'm thinking all the links that you had, nsa.) Where will this thread reside? I also think it might be a worthy thing to write up a bit about responsibility as a member of the recreational drug using community as a departure point for discussion.

Here is my edited version of what englandgz has done so far plus a final note about responsibility:

Is this an OD?

Assess the person’s condition:


Colour and temperature of skin.
Is skin blue or ashy in appearance? Is skin cold and clammy to the touch?

Breathing rate. Is the person breathing? If so, is the rate of breath normal or is it labored or too fast or too slow? If there is no breath, start rescue breathing (see below).

Pulse. Is there a pulse in the neck or wrist? Is it strong or weak? If they have a strong pulse and can be woken by shouting or giving them a shake they will still need to be closely monitored for the next few hours. If there is no pulse then full CPR is required. (See below.)

After checking these signs and assessing that an overdose is taking place, it is vital to immediately call an ambulance.

If there is someone else with you get them to dial 999/911 and explain in a clear and concise manner to the call handler what has happened and what you are currently doing. If you are alone then dial the number and put the phone on speaker so you can continue to help the person and talk to ambulance control at the same time. Try not to get flustered and remember they are asking you these questions for a reason. The police are often called at the same time. NEVER, NEVER compromise the aid you are giving to the victim by leaving them alone while you attempt to hide evidence. Any life is more important than legal consequences. Do not try to relocate the person on the verge of death.

Once the paramedics arrive, explain everything (and I do mean EVERYTHING) to them and let them take over. After that whatever happens will happen but the paramedics will be highly trained for this sort of thing and at least you will know you have done your best. If the procedures I have mentioned are carried out to the letter then there is an excellent chance you can save the person’s life.... If you do nothing then there is an equally high chance that they will die.



Assess exactly what they have taken. This is vital information for both you and the paramedics.
If this is an opiate overdose, narcan should be immediately given. If you have it on hand and can administer it yourself, do not hesitate. See administering narcan below.

Even if you have assessed that this is not an immediately life-threatening overdose it is important to understand that drug interactions and effects may still put the person’s life at risk even hours later. If you put them to bed MAKE SURE that they are on their side and not their back so they don't aspirate on their own vomit. Snoring or gurgling noises while sleeping may be signs of an inability to breathe properly and can be fatal.


How to do rescue breathing: needs text

How to perform CPR: needs text

Administering Narcan: needs text



A note about responsibility: Drug use is always a risk. Minimizing the risks is the focus of Bluelight’s mission. Preparing mentally and practically for being witness to an overdose is an acknowledgement of that risk. Take the time to learn how to do CPR, how to perform rescue breathing and when to use either or both. If you live in a country where narcan is available, learn how to use it and keep it on hand whenever applicable.
 
Would a possible addition of the subjective aspects of being 'the patient' suit?

I have OD'd on Opi/Benzo/EtOH combos, Opis alone, DRI stimulants and SSRA/MAOI induced serotonergic toxicity so can provide some data, if desired?
 
I've just remembered this (I've been mega busy with work and exams).

Some general notes on CPR...

Place hands on centre of chest. Rate should he around 120 compressions per minute at a depth of 5-6 cm with the heel of your hand (one hand on top of the other). If you know how to give rescue breaths then do so but make sure to manually clear the mouth of debris or vomit first and remember to tilt the head back. If the person has a suspected spinal injury then NEVER tilt the head back. If the person was familiar with the jaw thrust maneuver then this could be done but best just stick to compressions. Handy to have someone to take over if possible as continuous CPR is very tiring..

A good idea would be to have a look on you tube to see a demonstration of correct cpr technique.

I know it seems unlikely that an OD would take place in a public area but if it does and there is an AED (automated external defibrillator) then get this out straight after calling 999 these can be used with little to no training as they're voice prompted and have diagrams and instructions on the box. They assess the cardiac rhythm and deliver the shock automatically so it's difficult to go wrong. Once a person's heart has stopped their chances of survival go down by 7-10% every minute until a shock is delivered.

If you have narcan to hand then administer is as soon as the person has overdosed although if the person has already gone into cardiac arrest then narcan will be useless.

In terms of prognosis then after the person has gone into respiratory arrest cardiac arrest soon follows and it then depends on the quality of cpr, the use of a defib and the type of cardiac rhythm the person has. An AED as mentioned above will only shock Ventricular Fibrillation but the type of defib carried by paramedics will shock VF and pulseless Ventricular Tachycardia (heart rate >160) as well.

It really all comes down to time.

If you catch the person as soon as possible after overdose then narcan should bring them out of it. Any later than that and cardiac arrest will result. The persons only chance then is good CPR and the prompt arrival of paramedics. If an AED is available and you can use it then do so (if the person is not breathing and has no carotid pulse then this implies cardiac arrest but the machine will determine if the person is shockable)..

I wish I could think of anymore to write but I can't.

My best suggestion is go on you tube and see a demonstration of correct CPR technique and maybe look at how an AED works...Most importantly call an ambulance straight away....DO NOT DELAY FOR ANYTHING...

stay safe folks <3

Also...Yes sprout that perspective would be useful I think. Please do contribute.
 
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Just had another thought. The whole to give rescue breaths or not as a devisive issue and the medical profession changes its mind every 10 minutes anyway. Usually we as paramedics use something called an OPA (ora-pharangeal-airwar) to maintain a good airway and a BVM (bag valve and mask) connected to O2 (but doesn't have to be). If the person has just gone into CA then there will be enough oxygen in the lungs to support life and the most important thing is to get that blood pumping around the body and to the brain. Rescue breaths help a lot but if the person doesn't know what they are doing then they are easy to cock up. The process is to tilt the head back, clear the airway of debris and put your ear right over the persons mouth whilst feeling for the carotid pulse (neck) whilst also looking for chest rise and fall. Don't do this for more than 10 seconds as you don't want to delay cpr and 10 seconds should be more than enough. Also don't deliver massive breaths as all that will happen is you will end up blowing air into the stomach and tye person will vomit.

As a side not cpr is an excellent way to clear airway obstruction due to the pressure generated in the chest.

There's not much more I can say on cpr TBH but maybe looking at the wiki page or you tube would give a better understanding.....
 
What are everyones thoughts on beginning the process of taking everything and organizing it together and presenting it in an attractive final thread?
 
How does England think we should do this as e is the main player in this thread.

After thinking about the logistics due to how bl

My idea would be for anyone who wants to take a reread and or skim through whats been presented and come up with a plan or layout they feal would be good.. then post their take.

From any/all takes we draw up an outline and then we could divide the outline into post size subjects\topics with key points needed for each.

These could then all be placed in one post.. that way anyone who desires can volunteer to create a post off the list of thier choosing..

After all posts are claimed then we start the final thread.. this would just involving a title thread and the people posting a beginning post for thier contribution in the correct order.

Then it would be laid out well and the good people who are participating could work on their contributions useing the edit post feature when they wanted.

End results should be a nice strong OD prevention and first respone thread presented indi bl member style to be duplicated and promoted in appropriate areas of BL.

Thats my idea on a possible way we could proceed.

Sounds more complicated than it really is.. just need to makes sure all authors in the correct order to start..

I feel this is an important thread that could end up doing good for people.

What are others thoughts on how to proceed?

Englands the capn so we need the skippers take for sure and I just threw my idea out there.

Sent from phone.. so will edit later.
 
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Sorry neversickanymore mate, I've not been giving this my full attention as I've been having some issues at work that have had me distracted. putting the tread together will be the hard part I think. Ideally if I had the time I would volunteer to-do the whole thing but other folk have a lot to offer too. Why dont I concentrate on my personal area of expertise which is managing the overdose AFTER the point of respiratory and cardiac arrest I.e. CPR and use of an AED (defib). The only experience of narcan I have is the ampulues that we are provided with in our drug bags I've never even seen the ones that you guys in the states get given (intranasal) so maybe someone with some experience of these could write the narcan part.

I think yourself would be an ideal candidate for the general do's and don'ts as you know these as well as anyone and have a good concise writing style.

As for stimulant overdoses, this is a harder one as they are not as immediately treatable by a paramedic crew as opiate overdoses are.....

We aren't really trained for that. That's really for a doctor to manage. I mean we are trained to manage acute cardiac problems such as MI, and various forms of cardiac arrest but these are really worse case scenarios of stimulant overdose.

There is a British doctor (GP) who has recently joined bluelight who posts under the username pdj555 in the EADD section and he's a very knowledgeable guy. Maybe if you fire him a pm he might have some input as well.

Just tell me what you would like me to do mate and I'll get on it.

Cheers,

England
 
Hey england I know we exchanged some PM's over this.. I thought I would also post the work in progress outline here as well.

Hope your doing good. :)

neversickanymore said:
So since its your thread you should have the first post.. Possibly on stressing the need to call emergency right away and any other very key points that you feel should be first and foremost stressed.

Then I could take post number 2.. This could be like a title post with some graphics and some links to OD resources and groups

Then you can roll post 3 which could be a very basic list of what to do in order.. or it could have two lists a very basic one that covered the very important stuff for people who are not prepared and then are freaking and just need a short easy list of what to do.

Post 4 could be a how to on CPR with liked vids etc

Post 5 could be a much more detailed approach to OD presented list style as well.

post 7 could be overdose prevention

post 8 could be detailed opiate specific

post 9 could be detailed stimulant specific

etc etc

post 12 could be on dehydration

post 13 could be on narcan

post 14 could be a resources post for other links..

end post s summery type thing

So I think if we could first determine the layout of the thread in post to post plan style then we can draw up an final outline and start working on it.
 
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Just a heads up around this thread.. embedded video has been turned on in DC so we can use this as we create this thread. :)
 
good stuff

OVERDOSE SURVIVAL GUIDE

Tips for Safer Use & More


ODDguide-person.PNG
 
I saw in an above post about amphedamines can cause CA. What happens during a CA? My husband passed away 4 years ago (April 30th). Through out the night he had done over 1000 mg of morphine IV and then shot up Adderal (I'm not exactly sure, but not any more then normal). By the time he took the needle out and put it on the table he fell off the bed. I thought he was just too messed up and was like "WTF YOU DOING?!" and he was able to get out "I cant..." and it was like he was gone instantly. He was on my lap, I could tell that his body was trying to throw up as it often does when banging adderal, and he was gurgling but the life was out of his eyes. It was as if he was gone before I was even able to realize Wtf just happen. I am thankful my daughter, who was 8 at the time, was gone with my parents, but it was horrible waiting for the ambulance! We live in rural WI, where emt are volunteer, they are at home sleeping when they get the call. And even though the town is less that a mile wide it was about 10 minutes before they got there. I was frantic, people heard me screaming from across the block, and called 911 back to see where the ambulance was. Is this what happens with amphedamines? Or the combo of a downer AND then an upper in such high doses through Iv? I've always wondered what happened but I wasn't sure if I was able to get a coreners report, and now I of course don't think of it during the day when I am able to call and request it. If anyone knows what this is, it would be appreciated if I could know a little more about what happened.
 
It looks like this has stalled out so Im just going to start busting this out.
 
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I have come pretty near death twice from overdosing on synthetic cannabinoids. Both times, my blood pressure dropped extremely low. Last time it was down to 40something/28 and I think my pulse was really low. I was gasping for breath and barely able to get up. I was on the floor unable to rise for a few minutes. Be damn careful with those things and if you overdo it and feel your blood pressure is low or otherwise feel any distress, just call 911. I feel I was kept alive by external forces, if you know what I mean.

Not all of us are lucky enough to have higher beings protecting us. Most would have probably died over what happened last time, but I saw in a thread that someone knew it was happening as I am being watched and they used their power to keep me alive. And I did not mention that last incident on Bluelight. Not all of us are telepathic. Or getting "spiritual intervention".

Don't try to ride it out. You will likely die in such a situation :(
And I have seen some people post about using doses of cannabinoids that are so high I don't see how they are surviving it - they are not safe like weed. Perhaps my brain is unusually sensitive to their hypotensive properties. But please play it safe with those things!

If you have a stimulant on hand that can be smoked, that could possibly save you if you end up with severely reduced blood pressure but you should still seek emergency treatment, using that just to stabilize you while you wait for help to arrive unless you know it has reversed the problem and have someone around to watch you in case you take another turn for the worse. My blood pressure stayed very low (60s/70s over 35/50) for maybe 16 hours and lower than that the first 2 or 3 hours.
 
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I think there is a number besides 911 to call for cpr coaching. Some people just will not call the police.

I will say this, calling 911 sucks. If you got more than a gram of anything or more than one type of paraphenelia you get charged and the place usually gets ransacked.

I had my house searched when I overdosed and had some very serious charges. A bit of narcan would have really helped prevent the whole situation.

But does anyone know the American number to call for CPR coaching as I have narcan now and I would rather take my chances giving someone narcan and CPR than to call 911 as by the time they get there the persons fate is already decided so if someone is gonna live then calling 911 just assfucked a few people and if they were gonna die well the ambulance came far too late.

I am just saying that is the case if you find someone who's heart has stopped which is what happened to me. I learned alot about law because my lawyer was more interested in doing his cases in bulk with the DA and taking people's money and ended up firing my first lawyer. Once he said sure that wasn't (insert drug here) and winked I got fucking pissed because it wasn't that, it was fucking table salt and I wanted it tested and he wanted me to do 2 years and serve 8 on probation. So yeah I got 6 months probation versus hard time by educating myself.

I wish I had educated myself before something like that had happened. So I really suggest for anyone reading this to call their local HR people and get some narcan and drive to them if you have to because a human life is valuable and in all opiate OD cases I know the person died or came to before the ambulance came. In my experience the paramedics are more concerned with who you are, where you are, and what drugs where involved. When they got to my residence the cops tried to shove past the paramedics and the paramedic yelled at the cop "Are you fucking stupid, they called an ambulance."

The cops were already destroying my personal belongings and doing shit like picking up shoes of the rack looking in them and throwing them at the wall, that and pocketing drugs and tobacco.

In my experience a police officer doesn't give shit about a medical emergencey so I would just tell the police you think it is a cardiac arrest or seizure and they might show up faster without the police. I know that last sentence might be wrong but it is what I would do if I had to call an ambulance. I sure as hell would not say shit about drugs and I would probably leave after placing the call.
 
Above thread has a lot to sift through but I'd definitely be interested in putting in some work on this.

I'm halfway decent at making infographics and stuff like that, so perhaps a flow chart of what to do in certain situations in, e.g. a heroin overdose, how/when to check vital signs, prevent aspiration, assessment, when to apply tactile stimulus, when to use Narcan, when to 911, CPR, whatever ...

We were recently in PD discussing the pharmacological management of the "bad trip," which might be included under this umbrella to a certain extent.
 
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