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3. July 11]. Preliminary 2018 data shows decline in opioid deaths. Austin Daily Herald. //www.austindailyherald.com/2019/07/preliminary-2018-data-shows-decline-in-opioid-deaths/
4. Control and Prevention. [2021]. HAN Archive—00438 | Health Alert Network [HAN]. Center for Disease Control and Prevention. //emergency.cdc.gov/han/2020/han00438.asp
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6. Control and Prevention. [2023, August 8]. Understanding the Opioid Overdose Epidemic | Opioids | CDC. //www.cdc.gov/opioids/basics/epidemic.html
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9. Gilson, T. P., & Singer, M. E. [Flannery, D. J. [n.d.]. Cuyahoga County, Ohio, Heroin and Crime Initiative: Informing the Investigation and Prosecution of Heroin-Related Overdose: Final Research Overview Report. 2022]. Trends in opioid overdose fatalities in Cuyahoga County, Ohio: Multi-drug mixtures, the African-American community and carfentanil. Drug and Alcohol Dependence Reports, 4, 100069. Flannery, D. J. [n.d.]. Cuyahoga County, Ohio, Heroin and Crime Initiative: Informing the Investigation and Prosecution of Heroin-Related Overdose: Final Research Overview Report.
10. Gilson, T. P., & Singer, M. E. [2022]. Trends in opioid overdose fatalities in Cuyahoga County, Ohio: Multi-drug mixtures, the African-American community and carfentanil. Drug and Alcohol Dependence Reports, 4, 100069. //doi.org/10.1016/j.dadr.2022.100069
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12. to Patient Families Community EMS • Physical • Burnout • Addiction A continued overdose epidemic born on the backs of EMS
13. of designer/synthetic drugs Improved short-term incident management strategies Improved long-term care innovation
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27. they? What do they look like and how are they used? How are they dangerous? What are the signs and symptoms? How do I manage an OD?
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34. decorative foil packaging, glass vials, ziplock baggies, droppers, and lip balm-like containers • Bug repellent • Potpourri • Shoe deodorizer • Jewelry cleaner • Toilet cleaner • Energy enhancer • Bath salts • Glass cleaner • Fertilizer • Plant food • Decorative sand • Herbal incense Commonly sold in smoke shops, but may also be found in liquor stores, gas stations, convenience stores, the internet
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36. of Emergency Physicians’ Position Statement
37. existence of hyperactive delirium syndrome with severe agitation, a potentially life-threatening clinical condition characterized by a combination of vital sign abnormalities [e.g., elevated temp and blood pressure], pronounced agitation, altered mental status, and metabolic derangements. .
38. at high risk of direct physical trauma, not only unintentional harm from trauma such as falls, but also the metabolic stress that may result from physical restraint that may be required to facilitate the safety of the patient, bystanders, and responding professionals and ensure appropriate patient evaluation by EMS.
39. treating patients with signs of hyperactive delirium syndrome is to focus on reducing stress, preventing physical harm, and transporting them to an emergency department, where they can be treated by an emergency physician.
40. & de-escalate 3] Position & medicate* 4] Monitor & differentiate
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42. and pseudoephedrine moved behind pharmacy counter P2P methamphetamine: intense, long-lasting highs Extreme aggression and paranoia
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45. xylazine may be more difficult to identify in clinical settings, as they often appear similar to opioid overdoses and may not be included in routine drug screening tests. Xylazine has no approved antidote for human use, and as xylazine is not an opioid, naloxone does not reverse its effects. death. Overdoses associated with xylazine may be more difficult to identify in clinical settings, as they often appear similar to opioid overdoses and may not be included in routine drug screening tests. Xylazine has no approved antidote for human use, and as xylazine is not an opioid, naloxone does not reverse its effects. Consequently, the presence of xylazine may render naloxone less effective; however, the administration of naloxone can still address the effect of an opioid on breathing, which may be sufficient to prevent death.
46. & de-escalate 3] Position & medicate* 4] Monitor & differentiate
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58. & de-escalate 3] Position & medicate* 4] Monitor & differentiate
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60. described in 2004 in Adelaide Hills of Australia Cyclic vomiting in the setting of chronic, high-dose cannabis Frequently associated with compulsive hot baths/showers Galli, J. A., Sawaya, R. A., & Friedenberg, F. K. [2011]. Cannabinoid Hyperemesis Syndrome. Current Drug Abuse Reviews, 4[4], 241–249. //www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/ Sorensen, C. J., DeSanto, K., Borgelt, L., Phillips, K. T., & Monte, A. A. [2017]. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review. Journal of Medical Toxicology, 13[1], 71–87. //doi.org/10.1007/s13181-016-0595-z
61. to marijuana use have increased with legalization and greater availability National Institute on Drug Abuse. [2020, June]. What is the scope of marijuana use in the United States? National Institute on Drug Abuse. //www.drugabuse.gov/publications/research-reports/marijuana/what- scope-marijuana-use-in-united-states It is unknown whether this increase is due to increased use, increased potency of marijuana or other factors. Mentions of marijuana in medical records do not necessarily indicate that these emergencies were directly related to marijuana intoxication
62. and nausea upon waking. Possible increased intake of cannabinoids to treat persistent nausea. Can last for months to years Galli, J. A., Sawaya, R. A., & Friedenberg, F. K. [2011]. Cannabinoid Hyperemesis Syndrome. Current Drug Abuse Reviews, 4[4], 241–249. //www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/
63. abdominal pain, and retching Scromiting [screaming/vomiting] Episode length varies significantly Symptoms are cyclical and can recur in intervals of weeks to months Weight loss and dehydration due to decreased intake and vomiting Galli, J. A., Sawaya, R. A., & Friedenberg, F. K. [2011]. Cannabinoid Hyperemesis Syndrome. Current Drug Abuse Reviews, 4[4], 241–249. //www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/
64. days to months Weight gain, rehydration, sx relief If patient consumes cannabis symptoms tend to come back Asymptomatic periods sometimes referred to as the “Well Phase” Galli, J. A., Sawaya, R. A., & Friedenberg, F. K. [2011]. Cannabinoid Hyperemesis Syndrome. Current Drug Abuse Reviews, 4[4], 241–249. //www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/
65. injury including syndromic presentation Past medical history including marijuana use A physical exam Vital signs Capillary blood glucose check 12 lead EKG
66. perforation / obstruction Gastroparesis [stomach paralysis] Cholangitis [Inflamed bile duct] Cholecystitis [inflamed gall bladder / stones] Pancreatitis [enzymes digest the pancreas] Nephrolithiasis [kidney stone formation] Diverticulitis [infection / inflammation of pouches in intestines] Ectopic pregnancy Pelvic inflammatory disease Acute Coronary Syndrome [ACS] Acute hepatitis Adrenal insufficiency Ruptured aortic aneurysm Sorensen, C. J., DeSanto, K., Borgelt, L., Phillips, K. T., & Monte, A. A. [2017]. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review. Journal of Medical Toxicology, 13[1], 71–87. //doi.org/10.1007/s13181-016-0595-z
67. Mild to moderate skin burns • Electrolyte abnormalities [most commonly low potassium] • Dehydration or acute kidney injury • Muscle cramping or spasms Potential life threats • Pneumomediastinum from a ruptured esophagus • Electrolyte derangement causing seizures, arrhythmias
68. medication • Associated with bowel dysfunction • Could theoretically worsen CHS symptoms • Could potentially create opioid dependence Sorensen, C. J., DeSanto, K., Borgelt, L., Phillips, K. T., & Monte, A. A. [2017]. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review. Journal of Medical Toxicology, 13[1], 71–87. //doi.org/10.1007/s13181-016-0595-z
69. to severe dehydration and/or acute renal failure require aggressive fluid resuscitation Sorensen, C. J., DeSanto, K., Borgelt, L., Phillips, K. T., & Monte, A. A. [2017]. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review. Journal of Medical Toxicology, 13[1], 71–87. //doi.org/10.1007/s13181-016-0595-z
70. F., & Cascella, M. [2023]. Cannabinoid Hyperemesis Syndrome. In StatPearls. StatPearls Publishing. //www.ncbi.nlm.nih.gov/books/NBK549915/ • Senderovich, H., Patel, P., Jimenez Lopez, B., & Waicus, S. [2021]. A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options. Medical Principles and Practice, 31[1], 29–38. //doi.org/10.1159/000520417 • Sorensen, C. J., DeSanto, K., Borgelt, L., Phillips, K. T., & Monte, A. A. [2017]. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review. Journal of Medical Toxicology, 13[1], 71–87. //doi.org/10.1007/s13181-016-0595-z
71. departments have increases in cannabis related pathology “Cyclical vomiting” has doubled in Colorado following marijuana legalization Synthetic cannabinoid use is also on the rise and has been associated with CHS CHS often remains undiagnosed EMS is often the first medical provider to encounter the issue CHS patients often receive expansive diagnostics, numerous pharmacological interventions, and frequently require observation or hospitalization EMS understanding, assessment, and communication can improve the process Kim, H. S., Anderson, J. D., Saghafi, O., Heard, K. J., & Monte, A. A. [2015]. Cyclic vomiting presentations following marijuana liberalization in Colorado. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 22[6], 694–699. //doi.org/10.1111/acem.12655 Hopkins, C. Y., & Gilchrist, B. L. [2013]. A case of cannabinoid hyperemesis syndrome caused by synthetic cannabinoids. The Journal of Emergency Medicine, 45[4], 544–546. //doi.org/10.1016/j.jemermed.2012.11.034
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78. form can appear yellow, brown, or off- white in color. DEA regional forensic laboratories have seen this drug mixed into heroin and/or fentanyl [and marketed as common street drugs] with deadly consequences. ISO has already been seen pressed into counterfeit pills and falsely marketed as pharmaceutical medication [like Dilaudid "M-8" tablets and oxycodone "M30" tablets].
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82. [2021]. Innovations in Overdose Response: Strategies Implemented by Emergency Medical Services Providers.
83. patients linked to peer recovery support specialist services, 87 [60.84%] had accepted an NLB kit from EMS. The fully adjusted logistic regression model revealed that those whose kit was left with a family member on the scene were 5.16 times more likely to be connected to peer support specialists [OR = 5.16, CI= 2.35 - 11.29, p = 0.000] while those whose kit was left with a friend or given directly to the patient were 3.69 times [OR = 3.69, CI= 1.13 - 12.06, p < 0.05] and 2.37 times [OR = 2.37, CI= 1.10 - 5.14, p < 0.05] more likely, respectively, to be connected to follow up services as compared to those who did not accept a kit, controlling for other variables in the model. Scharf, B. M., Sabat, D. J., Brothers, J. M., Margolis, A. M., & Levy, M. J. [2021]. Best Practices for a Novel EMS-Based Naloxone Leave behind Program. Prehospital Emergency Care, 25[3], 418–426. //doi.org/10.1080/10903127.2020.1771490
84. Suboxone® [a combination of buprenorphine and naloxone] have been administered successfully within structured opioid overdose bridge programs. For patients who are not transported to a hospital, these medications prevent the onset of opioid withdrawal and can serve as a “bridge of survival” until the patient can be linked to drug rehabilitation resources. Hern, H. G., Lara, V., Goldstein, D., Kalmin, M., Kidane, S., Shoptaw, S., Tzvieli, O., & Herring, A. A. [2023]. Prehospital Buprenorphine Treatment for Opioid Use Disorder by Paramedics: First Year Results of the EMS Buprenorphine Use Pilot. Prehospital Emergency Care, 27[3], 334–342. //doi.org/10.1080/10903127.2022.2061661
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86. to Patient Families Community EMS • Physical • Burnout • Addiction A continued overdose epidemic born on the backs of EMS
87. of designer/synthetic drugs Improved short-term incident management strategies Improved long-term care innovation
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