Oxygen was administered through a nasal cannula at a rate of 6 liters per minute, and the patient was transported by ambulance to the emergency department of this hospital.
Several minutes later, the patient woke up, removed the oropharyngeal airway, and was noted to be alert and oriented, with a respiratory rate of 16 breaths per minute. The blood glucose level, obtained by fingerstick testing, was 164 mg per deciliter (9.1 mmol per liter reference range, 70 to 110 mg per deciliter ). An oropharyngeal airway was placed, and positive-pressure ventilation was initiated with the use of a bag–valve–mask device. He had pinpoint pupils and shallow breathing. The temperature was 35.6☌, the pulse 88 beats per minute, the blood pressure 122/76 mm Hg, the respiratory rate 4 breaths per minute, and the oxygen saturation 80% while he was breathing ambient air. On examination, the patient appeared cyanotic, and he had a Glasgow Coma Scale score of 3 (on a scale ranging from 3 to 15, with lower scores indicating lower levels of consciousness). First responders from the fire department had administered a second dose of intranasal naloxone before emergency medical services personnel arrived. The patient’s friend was present and reported that when he had found the patient, he had administered intranasal naloxone and then called for emergency medical assistance. on the day of this evaluation, emergency medical services personnel were dispatched to the park, where the patient was found lying on the ground in a puddle of slush. he remembered subsequently walking around a park and placing a phone call to a friend to arrange a meeting.Īt 2:44 p.m. On the day of this evaluation, the patient injected 0.5 g at 10 a.m., followed by another 0.5 g at approximately 1:30 p.m. He obtained the drug, which he believed to be mixed with fentanyl, from a single dealer and began to inject 0.5 g at a time using clean needles and cotton filters. He continued in this program and abstained from opioid use until 3 days before this evaluation, when he resumed intravenous heroin use. After 2 weeks, he was discharged home.Īpproximately 2 months before this evaluation, the patient was released from jail and was admitted to a structured residential rehabilitation program, in which he participated in work therapy, attended regular Narcotics Anonymous meetings, and underwent random, intermittent urine toxicology screenings. Six months before this evaluation, the patient again stopped using heroin and was admitted to an inpatient, medically supervised detoxification program for management of withdrawal symptoms. He began to take methadone, which helped to reduce withdrawal symptoms and cravings, but he stopped taking it after 10 days because he was concerned that weaning off methadone after a period of maintenance treatment would be associated with unacceptable adverse effects. One year before this evaluation, after the patient lost his job, he attempted to quit using heroin. During the next 3 years, he injected 1 to 2 g of heroin each day. After the patient was discharged home, he initially sought out more prescription opioids and then switched to intravenous heroin because he found it to be less expensive and more easily obtained. Immediately after the procedure, hydromorphone was administered. Martin (Emergency Medicine): A 36-year-old man with opioid-use disorder was seen in the emergency department of this hospital during the winter because of opioid overdose.Īpproximately 4 years before this evaluation, the patient had undergone an unspecified hand surgery. The most trusted, influential source of new medical knowledge and clinical best practices in the world.ĭr.
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