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Surviving Post Naloxone

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You find the patient – a young man – in respiratory arrest in a Honda with tinted windows behind a service station.  His head is back, his mouth is open, and he is deeply cyanotic.  His skin is warm and despite having no respirations, he has a pounding carotid pulse.  On the floor board you […]

Wild Wild West

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There is an anxious crowd on the corner of Hungerford as we come lights and sirens down Park Street.  A woman with tattooed arms waves for us to hurry.   A man is on the ground with a crowd clustered around him.   I can see another man kneeling over his chest. His arms together like he […]

Grade A

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The man kneels in the grass next the pickup truck that has its door open. He vomits.  The fire department is standing over him.  “Citizen Narcan found him in the truck passed out, squirted him with two doses and then took off when we got here,” a firefighter tells me. I see the two 4 […]

Fentanyl Safety

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Finally! The Federal Government has listened to the experts and released sensible evidenced-based recommendations on safety for first responders when encountering fentanyl and fentanyl analogues, including carfentanil. Fentanyl Safety for First Responders The document issued yesterday by the White House National Security Council is the product of their Federal Interagency Working group with collaborative support […]

Hope

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The call is for an overdose in the stairwell of the apartment building. Fire has arrived just before us – they have propped the front door open. I enter with my house bag over my shoulder and carrying the cardiac monitor in my right hand. There is no one in the dim lobby to direct […]

Controversies and Carfentanil

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Great article in the November 2017 edition of the  American Journal of Emergency Medicine about the  controversies surrounding the dangers of carfentanil, fentanyl and other fentanyl analogues.  The physician authors, John B. Cole and Lewis S. Nelson, take the Drug Enforcement Agency (DEA) and the media to task for sensationalizing the dangers to responders of these synthetic opioids. […]

Katrina Journal: What’s Important

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In view of Hurricane Harvey and the rescue efforts now underway, I am posting notes from my journal when I was posted in Gulfport, Mississippi in the aftermath of Hurricane Katrina. Day One: Waiting On the morning of September 17, we meet at the office and a chair van driver takes us up to the […]

Light Weights – Heroin Math 2 (Why We Don’t Get Robbed of our Fentanyl)

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You carry four 100 mcgs vials of Fentanyl in your controlled substances kit.  How much would those vials be worth on the street? Let’s do the math. 100 mcgs of Fentanyl is the equivalent of 10 mgs of Morphine. Morphine is 50% as strong as heroin. Morphine is the equivalent of 50% pure heroin. A […]

An Offer Hard to Refuse: Heroin Math 1 (Pills to Mainlining)

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Thesis: People addicted to prescription painkillers who buy their pills on the black market switch to heroin because it is a better economic deal (cheaper and stronger). The Situation: When a person’s painkiller prescription runs out or their tolerance outruns their prescription, and the user still needs opioids to keep from being sick, the user […]

Fact or Fiction

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Great article on ems1.com Medical commentary on the issue of danger to first responders of transdermal fentanyl exposure. Dr. Tan, discussing transdermal fentanyl exposure, agrees that exposure as would be typically encountered by first responders is an extremely low risk. “It is not zero risk and certainly not impossible, but extremely low,” he said. Fact or […]

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