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Workshop: Help BL create an Overdose Resource Sticky

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Felonious Monk

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It has recently come to the attention of the mod team that there is not enough immediately available information regarding overdoses--what to do in the event of one, how to recover, whether to call 911, etc..

This effort will be spear-headed by several of our community members, but I'm asking for feedback from the board as a whole on what information should go into this resource.

Please keep posts to constructive help.
 
 
I think the focus should be mainly on overdoses of opiates and opiate/benzo combinations as these tend to present the most immediate threat to life. We can add on a stimulant od piece as well though.

The thing is that anyone can Google overdose and get the standard internet generic answer. I would like to focus more on real life situations (as I've seen more than my share) the signs of an od. What to do versus what not to do. What to tell me the paramedics, the CORRECT way to give CPR etc.

I'd like to take a little time to put something together and submit it for review and criticism and what we can add or remove to make it more user friendly and easy to understand for the layperson.
 
I have a few things I would also like covered and will work on my contribution as well.

neversickanymore said:
I think a main focus we should have is that if an OD happens they need to seek medical advise right away. It could focus that with taking potentially deadly drugs comes the responsibility to help yourself and others if this happens. Maybe some things to try and put what is happening into perspective.. like its to late to worry about what family members will think because they will think a live person is much better than a dead person. Maybe consider adding some information that shows why quick and proper response is crucial.. like how prolonged time where the brain receives limited oxegen due to the central nervous system being to depressed due to the OD.., can have lasting effects. How it is important that if a person OD's it can be really helpful for people who know what they took to talk to first responders or medical personnel so that proper treatment has a better chance of being administered. That its a good idea to remove the drugs from one's presence when going into deal with this. We could also stress the idea that people should seek and find narcon if its available in their area.
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I also want to see mention of how important it is to monitor a person that has ODed. I know of cases that people were brought out of the OD and were walking and talking and people left that person alone and went back to useing or watever only to return to check on the person i find them dead.
 
Yeah definitely..... Plus people need to know the difference between CPR and rescue breathing. Generally if a person is in cardiac arrest they tell members of the public who aren't familiar with CPR not to bother with rescue breaths and just concentrate on chest compressions. The reason for this is there still should be enough oxygenated blood in the system but the most vital thing is to keep that blood pumping to the brain and vital organs (the exception to this is giving CPR to children). Also most people get the rescue breaths wrong and don't tilt the head back far enough and just end up breathing into the persons stomach. Usually in the early stages of an opiate od the person won't be in cardiac arrest (obviously check for a pulse) but will have stopped breathing since the opiates suppress the automic breathing response. In this case rescue breathing is ESSENTIAL. The number one thing really is to call 911 (999 in the UK) and tell the paramedics what has happened. Start rescue breathing immediately by tilting the persons head back, pinching their nose and giving two breaths while forming an airtight seal over the mouth. If narcan is available then administer immediately but also remember that the half life of narcan is shorter than a lot of opiates and therefore may have to be readministered. Also never assume that just because the narcan "appears" to have brought the person round that you no longer need to call an ambulance.......you do.

This is just stuff off thetop of my head. II'll write something properly later
 
Also NEVER postpone calling an ambulance call immediately as soon as you think the person has overdosed. Signs include shallow or non existent breathing, cold clammy skin, skin, lips and fingernails turning blue (for black people its more of a light grey pallor). Check the airways for any obstructions and begin rescue breaths immediately. If possible have another person call the ambulance while you are doing this. Don't fuck about trying to hide evidence or clean up if doing this delays helping the person or calling the ambulance. I don't know how common narcan kits are in the us (they are very rarely given in the UK) but make sure you are familiar with how to administer it and do so promptly. As I said before even if the person comes round and seems fine, still call the ambulance due to the fact that the half life of narcan is so short, the patient can slip back into od when the narcan wears off.

Also just to add to my previous post about rescue breathing....to see if a person is breathing or not look at their chest to see if it rises and falls and put your ear to their mouth and nose and it should be evident if they are breathing or not. When rescue breaths are performed properly you should be able to see the chest rise and fall. Test either the corotid or radial artery for a pulse and if non is found begin chest compressions ....30 compressions interspaces with two breaths.

This isn't meant as a definitive guide....I'm just typing things on my cell phone during my work breaks as they come to mind. Hopefully others will chip in aswell
 
but also remember that the half life of narcan is shorter than a lot of opiates and therefore may have to be readministered.
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Way shorter..

Everything you have mentioned I great and rite on IMO. I think we can create a very strong thread here=D
 
Thanks neversickanymore for you contributions and comments. I know this was kind of my idea and I could write up a pretty good piece on my own but I (and I'm sure the mods would prefer it) would really likeother members to contribute what they can . Maybe some who have actually suffered an od and survived could come up with something from that perspective.... What they learned, what it felt like etc.

Anyway. I'm off this weekend so will type something up but would really like for this not to become just another "uh.....yeah....what he said!" Kind of thread.

Come on guys and girls what you write could potentially save the life of another human being and believe me......there is no more profound sense of achievement and inner joy than that the which is obtained from doing so.
 
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Rough format.....

Assess the persons condition. Colour and parlour of skin, breathing rate, check for pulse. Assess exactly what they have taken and if they are breathing fine and have a strong pulse simply try to wake them by shouting their name, giving them a shake etc. If they come round then fine. As a paramedic I have to say that you should phone an ambulance anyway but I know a lot of people won't. If you don't then make sure to monitor them closely for the next few hours and 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. Really if you have any concerns at all you should dial 911/999 just to be on the safe side.

If they are cold and clammy to the touch, blue/grey skin pallor and have stopped breathing then immediately start to perform rescue breathing. Check for a pulse in the radial or corotid artery (neck or wrist) and if one is found just continue to rescue breath....if one isn't found then the person has gone into cardiac arrest and full CPR will be required note cardiac arrest and a heart attack (myocardial infarction) are NOT the same thing. I've gone into the details of how to do rescue breathing above so won't go into it in too much detail again other than to say tilt the head back, check the mouth for obstruction, pinch the nose, form a seal around their mouth with your mouth and give 2 strong breaths interspaced by a second or two. If you also need to perform chest compressions then its 30 strong compressions in the chest using the heal of your palm with both hands (one on top of the other)...the best analogy I remember for the rythem of the compressions is the bee gees "stayin alive"... In fact the was a TV advert in England by the actor Vinny Jones and this was what they suggested and tbat always sticks in my mind during CPR.

In most cases the person will still have a pulse so this won't be necessary only rescue breathing will be needed. 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 the dial the number and put the phone on speaker and lay it on the floor or something 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. I don't know about the US but in the UK the police are often called at the same time and when we arrive the police will already be there (but not always). They don't routinely arrest everyone but try to use common sense regarding not leaving drugs and paraphernalia laying around for them to find (side note...NEVER, NEVER compromise the aid you are giving to the victim buy leaving them alone while you attempt to hide evidence..... their life is more important..... Same for trying to drag them out the house and dump them on the pavement or something).

Another thing I'd like to mention is that if someone ODs at a property whereby there are known to be small children living (and especially if drugs and parphenalia are also found) then a safeguarding referral will be made to social services (I'm on about the UK here). This will then be investigated to see if the children are at risk. This may seem harsh but really having babies and toddlers upstairs while adults are shooting and ODing on heroin in the living room is clearly not good for the wellbeing of the child and will be looked into ....what will happen depends on the individual case.

With regards to administering narcan.....it isn't routinely given out in the uk (although iirc there was a trial in Scotland a few years back) so its less of an option to people in Britain but in the states if you have narcan (usually the nasal delivery system I believe) then use it as you have been haughty....but still call theambulance anyway due to the aaforementioned short half life of narcan that neversickanymore spoke about above.

Once the paramedics arrived explained. 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 outto the letter then there is an excellent chance you can save the persons life.... If you do nothing then there is an equally high chance that they will die.

I know I've said this before but I'm just typing shit as it co.es to my head on my iPhone since my laptop appears to be fucked (technical term Lol!).

Feel free to merge, cut and paste etc.

I will add more later....please help by adding contributions though folks. Your input could make all the difference.

My sincere thanks to neversickanymore and felonious monk for their help and support and for making this whole resource a possibity. Both of these guys are obviously kind conscientious people who have helped make available a resource that potentially could save the life of someone reading this and that is a fantastic thing. My own life is dedicated to saving others and helpng my fellow man and woman however I can and it is heartwarming to see others do the same. It really is the best feeling in the world.

Thank you for listening to my sleep deprived ramblings and apologies for all the cell phone induced typos!!

Stay safe and god bless all.....
 
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Stimulant overdoses....amphetamines.

Generally a lot simplier. If no acute toxicity is present the a benzo is often used (titrated) for sedation any possible seizures and cooling methods (ice packs etc) if hyperthermia is present. Activated charcoal can be given in cases of a cut oral ingestion.

Cardiac issues if they arise are usually treated in the usual way with nitroglycerine, electocardiogram, aspirin etc Significant cardiac dysrhythmias may require cardioversion, defibrillation, and antidysrhythmics.

With stimulant overdoses most of the care is given by hospital staff as paramedics arnt really trained or equipped to deal with them. The best that can be done by us (ambulance) is to manage any acute cardiac issues that are likely to be fatal there and then such as an MI, administer midazolam if a seizure is occurring and obtain iv access to get fluids in.....then drive like fuck to the nearest hospital and then its up to the doctors who have much more training to deal with it.

Although the duties of paramedics and EMTs are expanding all the time to increase skill levels and treat patients at the scene rather than convey everyone to hospital (where possible)...we arnt doctors and only have a limited amount of training and variety of drugs and equipment at our disposal. The main thing is to keep people alive long enough to get thme to the people who can best care for them I.e. hospital... not to be able to great every known condition ourselves which would be impractical and infeasible.
 
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Great work E=D

When we eventually present this I feal its important that we consider that we will be presenting this to people of all walks of life, education backgrounds, first languages, and that they may also be in kinda a panic.. so we will want to eventually present this in the clearest most strait forward approach.. we can also include more in depth information.. but I think it absolutely key we present this in a clear easy to remeber, understand, and follow list as i think this approach will end up having the most positive results.. remeber you have an education and training designed for this, but how can we make it accessible to everyone. Then we can provide more technical information as well. But streamlining the process into a easy step by step Is essential.. then we can expand it latter in the thread.

Does this makes sense.. a list of what to do in order.. simple and then latter on we can explore specifics and why?

englandgz74 said:
Yeah I was thinking that also.... Its just a load of thoughts in a fairly random order at the moment and needs to be presented better in an easy to follow way. Now most of the basic info is there it needs to be presented far better and in easy to follow steps. I'll have a think......
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!!IF SOMEONE IS OVERDOSING RIGHT NOW CALL EMERGENCY RESPONDERS IMMEDIATELY!!



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OVERDOSE PREVENTION AND MANAGEMENT

"Deaths from drug overdose have been rising steadily over the past two decades and have become the leading cause of injury death in the United States. Every day in the United States, 114 people die as a result of drug overdose, and another 6,748 are treated in emergency departments" source ​


PREVENTION
INFORMATION
MANAGEMENT
LINKS

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​
 
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If we were to put together a concise list how would it go. Here is a starting point to examine.

1) remove any obstruction to breath
2) call emergency services
3) administer narcan if relative


WHEN TO CALL AN AMBULANCE

People are often reluctant to call an ambulance for fear of police involvement or concern about the cost of a call-out. The police will only attend if there is a fatality or if their presence is requested, for example if the ambulance crew feel threatened. This is an issue worldwide.

In addition to unconsciousness, call for emergency help when someone is:

-having a seizure
-experiencing severe headache
-experiencing chest pain
-experiencing breathing difficulties
-extremely paranoid, agitated and/or confused.
-It is not necessary for someone to have all of these signs or symptoms for them to be overdosing. Exhibiting only a few could still mean nthey are in trouble and need emergency help.

DON’T IGNORE GURGLING AND SNORING

Snoring and gurgling can mean a person is having trouble breathing.

With substance use, especially substances that slow down the systems of the body (eg: benzodiazepines, opioids, GHB), snoring may indicate a serious and potentially life threatening obstruction of the airway.

The noise generated results from reduction in the size of the airway, and the result is a reduction in the volume of air that is able to move in and out of the lungs with each breath, and vibration of tissues around the airway as the comatose person struggles to move air in and out of the lungs. The larger the obstruction, the smaller the amount of air that gets in, and the greater the effort that is required to try and get air into the lungs. The obstruction occurs when the person is unable (due to their substance use) to move their head/neck/body to allow better air flow, and because collapse of the airway due to decreased muscle activity around the airway that normally keeps it open – this is because they are unconscious, not because they are sleeping.

In the setting of substance use, snoring is not something that should be seen as ‘normal’. Don’t let people ‘sleep it off’ if they are snoring – this may be a sign of significant and life threatening emergency – attempt to wake them immediately.

If they do wake then the snoring (airway obstruction) will resolve. If they do not wake, call emergency services and ask for an ambulance. Follow the instructions from the operator (you will probably be asked to roll the snoring person onto their side and open their mouth to maximise the flow of air).

NALOXONE HALF-LIFE

Naloxone or Narcan is the used by paramedics to revive people who have had an opiate or opioid drug overdose. Anyone who has been revived using naloxone needs to understand the danger of taking more drugs afterwards because they can overdose a second time. Naloxone can precipitate withdrawal symptoms which bring a powerful urge to take more drugs. Because naloxone has a half-life of 1-1.5 hours, considerably less than heroin and morphine, taking more opiates can bring on a second overdose. Drugs like methadone, and sustained-release opioids like OxyContin and MS Contin, provide the drug over 12 hours or more, so the effect of naloxone will wear off long before those drugs have exited your system.

PERMANENT BRAIN DAMAGE AND OVERDOSE

Hypoxic brain injury, which is caused by a lack of oxygen to the brain, is an under-reported consequence of heroin overdose. 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 without adequate oxygen supply. Basically, the longer a person is not breathing, the more potential damage is being done to the brain. In many overdose cases such information is unknown. Health outcomes depend on the success of damage control measures, the area and extent of brain tissue deprived of oxygen and the speed with which oxygen was restored to the brain.

A brain injury can result in mild to severe impairment of:

-movement, balance and co-ordination
-senses such as hearing or vision
-spoken and written communication
-thinking, concentration and memory.
-In severe cases, brain injuries from overdoses can leave people in a vegetative state.
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source
 
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^ I agree.. I think whenever you are able.. lets create this in an attempt to save as many good peoples lives as we can.

Im very sorry for your lose<3
 
Will chime in when i have time on methoxetamine overdose, the cause(s), and what happend to me after one occasion, 3 years ago, and possibly also the other saturday to a lesser extent (i am waiting on blood test results, and do not want to speculate and go into "what if's" for the moment), i am suffering from muscle pain since sunday morning, which reminds me how i felt 3 years ago after OD'ing, so am resting at home and am on sick leave from work, following my docs advice.

Briefly, 3 years ago an MXE OD, led to kidney failure and muscle pains which was due to muscle atrophy, i think caused by the kidney failure, so after being woken from a 2 day artificial coma, i had to spend 6 days on an IV drip to clean up my kidneys and get them working properly again, and make sure there was no serious irreversable damage done.

My blood tests i did this past monday morning results won't be in till next monday evening...

also

I know a BL'er who could chime in on APB OD, or abuse and what it resulted in, i will PM him soon, hopefully he's willing to share here.

Unfortunately i doubt mine and his are the only RC OD "stories" how they resulted, what measures to take to eliminate or minimise as much as possible the risks.

Great idea for a thread, HR info needs to be more widespread (in your face..) on BL, hopefuly people will realise how serious, and important it is to have all the knowledge possible before doing a substance whether naive to it or not, put all the odds on one's side, and what "neversickanymore" said above...

PEACE!
 
englandgz74 said:
Unfortunately I had to live through the scenario that we are trying prevent for real. Several weeks ago, I found my room-mate dead from am overdose (tox report not back yet but suspected opiate/benzo combo). While I administered CPR and when the ambulance crew arrived they did all they could but to8 no avail. While I'm no stranger to all this (people dieing/giving CPR etc.) it's VERY different when it's someone you know. I think what all the CPR demos in the world can't replicate is the feeling of fear that this brings with it. In this case he was too far gone for naloxone or even defibrillation to be of any use and he died.

If I had found him earlier then things might have been different but after the patient has stopped breathing, they will quickly go into cardiac arrest and when blood flow to the brain stopps, they are dead. If this is caught in time then they can possibly be saved by using the procedures outlines in this thr4ead but if medical help is not swiftly forthcoming then death is inevitable.

The incident affected me profoundly and I'm still struggling to come to terms with it for many reasons which I won't bore everyone for mentioning here
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I have been through an very similar experience and have never recovered from that. Hope you can move on..
 
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