People that experience a nonfatal overdose, as well as their friends and family can benefit from having access to naloxone. Physicians can prescribe naloxone to patients, who can then fill their prescription at a pharmacy that is authorized to dispense naloxone. Connection to a social support network and culturally-specific recovery supports are both very important to preventing opioid overdoses and maintaining substance use recovery. The Minnesota FastTracker has the option to search for culturally-specific substance use treatment options across the state.
Recovery support services include continuing care with a medical team, mutual support groups such as twelve-step programs, and peer recovery services that connect a person with others with lived experience of substance use and recovery. The Minnesota FastTracker can be used to search for outpatient, peer recovery, and recovery support groups. Recovery supports that have providers with diverse racial, ethnic, and gender identities is important for patients to feel recognized and have any experiences of discrimination and racism validated.
Groups of people that can benefit from culturally-specific recovery supports include people of color, Indigenous people, foreign-born people, and people who speak a language other than English. A major risk factor for experiencing a second overdose is a lack of stable housing and homelessness. Housing options for people who experience an overdose and want to abstain from substances can be difficult to find in the community.
Heard cited the case of a yearold alcoholic woman. The patient had no history of toxic alcohol ingestion but presented after a few days of vomiting and headache. She had very low serum bicarbonate, very high anion gap acidosis, no detectable ethanol, essentially normal blood glucose and only slightly elevated creatinine. The patient was unlikely to have diabetic ketoacidosis, Dr. But the treatment was the same: Two liters of D5 saline over a couple of hours, and repeating labs in two hours.
If the patient is likely to respond to treatment and has been blocked with an alcohol dehydrogenase inhibitor, Dr. Heard advised, hospitalists should get a nephrologist on the case and consider dialysis. Prudent use of tox screens For hospitalists trying to get to the bottom of a suspected overdose, toxicology screens can be immensely useful.
Heard advised being skeptical if a patient reports cold medications as an explanation for a positive amphetamine screen. On a positive note, you can use reference labs to test for just about anything, said Dr. Then they can actually help you a lot more. New thinking in toxicology. He presented a session on drug overdoses at the Society of Hospital Medicine annual meeting in San Diego.
One development is the emerging use of lipid infusion to address cardiovascular poisons. If ALT levels rise dramatically with continued acetaminophen, however, Dr.
Heard advised reducing the dose or eliminating the medication rather than ordering an extensive hepatitis workup. However, for acetaminophen or promethazine overdose, activated charcoal can decrease symptoms and, in the case of promethazine, possibly reduce the need for adaptive positive airway pressure.
Sunday, November 14, Today's Hospitalist. Home Addiction Medicine Handling drug overdoses in the hospital setting. How physicians can avoid pitfalls in social media.
Sliding scale insulin for inpatients gets some respect. Make sure you hire right. Recent articles. Tips for negotiating compensation May We studied their longer term functional outcomes and recovery patterns which have not been well described.
All patients admitted to the bed ICU of a university-affiliated teaching hospital following drug overdoses between 1 January and 31 December were identified. With ethical approval, we evaluated the functional outcome and recovery patterns of the surviving patients 31 months after presentation, by telephone or personal interview.
These were recorded as Glasgow outcome score, Karnofsky performance index and present work status.
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