Title: Designer Drug Evolution: Managing Uncontrolled Patients On Controlled Substances
Description: Emergency services are confronted by horrific events caused by a surge in the use of new types of designer drugs. In this program we'll use real world case studies to discuss the up-surge in mephedrone based drugs (“bath salts” and more), synthetic marijuana, salvia divinorum, datura weed, molly and more; what these drugs are, where they've come from, and what form they may take in the future. We'll also discuss what regulators and law enforcement are doing to stop them, and what field providers can do to manage the fallout from this new wave of designer drugs.
Teaching Formats:
-Lecture
-Discussion
-Case Studies
-Question and Answer
Learning Objectives: Students will be able to:
- Identify, assess and manage designer drug abusers in acute crises and overdose situations.
- Coordinate response and scene management across emergency services for designer drug emergencies.
- Provide both basic and advanced emergency medical care for designer drug abuse and ex-cited delirium.
- Understand past, present and future development of designer drugs presented through his-torical and contemporary case studies.
As seen in Fire Engineering Magazine’s Fire/EMS Column
Revised for 2024
Regular medical and recreational use of cannabis is on the rise among all age groups. In most cases, this is associated with few side effects, but some regular users experience a wildly paradoxical reaction. While cannabis will normally suppress nausea and pain and stimulate appetite, weekly cannabis use can sometimes produce severe cramping, abdominal pain, vomiting, and nausea, known as cannabinoid hyperemesis syndrome (CHS). In this program, we explore the pathophysiology of CHS, discuss presentations that EMS may encounter, and review the current diagnostic and treatment criteria. Current estimates of cannabinoid hyperemesis syndrome affecting potentially 2.7 million people in the US annually, with significant increases in states with legalization. With complica-tions of CHS including kidney failure, electrolyte imbalance and skin burns on patient seeking self-treatment, can EMS providers afford to be unprepared?
Teaching Formats:
-Lecture
-Discussion
-Case Studies
-Question and Answer
Learning Objectives: Students will be able to:
- Appreciate the acute and chronic hazards presented by cannabinoid hyperemesis syndrome
- Describe the three phases of cannabinoid hyperemesis syndrome
- Identify prehospital presentation signs and symptoms of cannabinoid hyperemesis syndrome with a focus on differential diagnosis
- Debate current theories of the pathogenesis of cannabinoid hyperemesis syndrome
- Describe immediate EMS as well as long-term treatment for cannabinoid hyperemesis syndrome
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Polypharmacy appropriate and inappropriate based on risk and benefit assessment case study, negative consequences of polypharmacy, deprescribing tools,
Personalized medicine involves the prescription of specific therapeutics best suited for an individual based on their genetic or proteomic profile. This talk discusses current approaches in drug discovery/development, the role of genetics in drug metabolism, and lawful/ethical issues surrounding the deployment of new health technology. I highlight some bioinformatic roles in the drug discovery process, and discuss the use of semantic web technologies for data integration and knowledge discovery..
Regular medical and recreational use of cannabis is on the rise among all age groups. In most cases, this is associated with few side effects, but some regular users experience a wildly paradoxical reaction. While cannabis will normally suppress nausea and pain and stimulate appetite, weekly cannabis use can sometimes produce severe cramping, abdominal pain, vomiting, and nausea, known as cannabinoid hyperemesis syndrome (CHS). In this program, we explore the pathophysiology of CHS, discuss presentations that EMS may encounter, and review the current diagnostic and treatment criteria. Current estimates of cannabinoid hyperemesis syndrome affecting potentially 2.7 million people in the US annually, with significant increases in states with legalization. With complica-tions of CHS including kidney failure, electrolyte imbalance and skin burns on patient seeking self-treatment, can EMS providers afford to be unprepared?
Teaching Formats:
-Lecture
-Discussion
-Case Studies
-Question and Answer
Learning Objectives: Students will be able to:
- Appreciate the acute and chronic hazards presented by cannabinoid hyperemesis syndrome
- Describe the three phases of cannabinoid hyperemesis syndrome
- Identify prehospital presentation signs and symptoms of cannabinoid hyperemesis syndrome with a focus on differential diagnosis
- Debate current theories of the pathogenesis of cannabinoid hyperemesis syndrome
- Describe immediate EMS as well as long-term treatment for cannabinoid hyperemesis syndrome
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Polypharmacy appropriate and inappropriate based on risk and benefit assessment case study, negative consequences of polypharmacy, deprescribing tools,
Personalized medicine involves the prescription of specific therapeutics best suited for an individual based on their genetic or proteomic profile. This talk discusses current approaches in drug discovery/development, the role of genetics in drug metabolism, and lawful/ethical issues surrounding the deployment of new health technology. I highlight some bioinformatic roles in the drug discovery process, and discuss the use of semantic web technologies for data integration and knowledge discovery..
Running Head GASTROINTESTINAL TRACT1GASTROINTESTINAL TRACT3.docxjeanettehully
Running Head: GASTROINTESTINAL TRACT 1
GASTROINTESTINAL TRACT 3
GastroIntestinal Tract
Name
Institution
Course
Date
GastroIntestinal Disorders
Introduction
Normally, gastric acids are produced and stimulated so that the body can break down consumed foods and digest them easily. The major component of gastric juice is hydrochloric acid, which is produced by oxyntic cells. The secretion of these acids takes place in three phases namely: the cephalic phase, the gastric phase and the intestinal phase. The cephalic phase starts when someone has an urge to eat or smells food. The brain signals the parietal cells to secrete gastric acids and the ECL to secrete histamine. The gastric phase is when someone has eaten and the amino acids present in the food stimulates the production of these acids. The last phase is stimulated by the distention in the small intestines and the amino acids too and the secretion takes place when chime enters the small intestines (Testani et al., 1996).
Gastroesophageal Reflex Disease (GERD)
There are gastrointestinal orders that exist, such as Gastroesophageal Reflex Disease (GERD), Peptic Ulcer Disease (PUD) and Gastritis disorders. Patients suffering from GERD have a complex gastric acid secretion caused by frequent acid reflux. There are cases where HCL frequently flows back to the esophagus and when this happens, the lining of the esophagus becomes irritated. The age factor is visible in this disorder. Older people are more likely to experience this disease than young. However, symptoms are less visible in the elderly. The fact that there is no serious warning symptom of GERD among the elderly makes the disorder more complicated in them. GERD can be diagnosed by a probe test, upper endoscopy or x-ray of the upper digestive system. For the elderly, adequate doses of medication that do not harm the digestive system are effective. Medical therapeautic agents, including PPIs such as pantoprazole and Omeprazole, can also cure GERD.
Peptic Ulcer Disease (PUD)
PUD is caused by an imbalance between the secretion of gastric acid and duodenal mucous defence. When the balance between the two is disrupted, there is a consequence of mucousal injury and hence peptic ulcers. PUD among the elderly is associated by complications and when administering medication, special attention should be given to the elderly since they respond negatively to medications and surgery. PUD can be diagnosed by carrying out both physical and diagnostic tests (Okello, et. al, 2016) . Once it has been diagnosed, laboratory tests can then be undertaken such as breath tests, stool and blood tests. There are two main factors that contribute to the high rate of PUD among the elderly are the high rates of H. Pylori and prescription of drugs that increase damage in the gastroduodenal drugs. Elderly patients receive medical treatment of PUD
Gastritis Disorders
Gastritis disorders basically results from mucous injury that may have been caused by ...
Treasure, J., Claudino, A. M., & Zucker, N. (2010). Eating disorde.docxwillcoxjanay
Treasure, J., Claudino, A. M., & Zucker, N. (2010). Eating disorders. The Lancet, 375(9714), 583-93. Retrieved from http://search.proquest.com/docview/199059169?accountid=87314
Eating disorders
Treasure, Janet; Claudino, Angélica M; Zucker, Nancy.The Lancet375.9714 (Feb 13-Feb 19, 2010): 583-93.
Turn on hit highlighting for speaking browsers by selecting the Enter button
Show duplicate items from other databases
Abstract (summary)
TranslateAbstract
[...] binge eating disorder is often associated with obesity. Investigators of a study of a large sample of American children aged 9-14 years reported that 7.1% of boys and 13.4% of girls displayed disordered eating behaviours.35 The pivotal effect on health has led to the inclusion of eating disorders among the priority mental illnesses for children and adolescents identified by WHO.36 Eating disorders have been reported worldwide both in developed regions and emerging economies such as Brazil and China.37,38 The lifetime prevalence of eating disorders in adults is about 0.6% for anorexia nervosa, 1% for bulimia nervosa, and 3% for binge eating disorder.19,20 Women are more affected than are men, and the sex differences in lifetime prevalence in adults could be less substantial than that quoted in standard texts: 0.9% for anorexia nervosa, 1.5% for bulimia nervosa, and 3.5% for binge eating disorder in women; and 0.3%, 0.5%, and 2.0%, respectively, in men.20 Many people with eating disorders, who were detected in community studies in the USA, do not seek treatment.20 Pathogenesis A comprehensive review published in 2004 summarised the risk factors for eating disorders,39 and a position paper from the Academy of Eating Disorders outlined the evidence supporting these diseases as biologically-based forms of severe mental illnesses.40 In this section we draw attention to some present areas of emphasis.
Full Text
TranslateFull text
Headnote
This Seminar adds to the previous Lancet Seminar about eating disorders, published in 2003, with an emphasis on the biological contributions to illness onset and maintenance. The diagnostic criteria are in the process of review, and the probable four new categories are: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. These categories will also be broader than they were previously, which will affect the population prevalence; the present lifetime prevalence of all eating disorders is about 5%. Eating disorders can be associated with profound and protracted physical and psychosocial morbidity. The causal factors underpinning eating disorders have been clarified by understanding about the central control of appetite. Cultural, social, and interpersonal elements can trigger onset, and changes in neural networks can sustain the illness. Overall, apart from studies reporting pharmacological treatments for binge eating disorder, advances in treatment for adults have been scarce, other than interest in new f ...
Assessment of the Abdomen and Gastrointestinal SystemDigestion, .docxcargillfilberto
Assessment of the Abdomen and Gastrointestinal System
Digestion, motility, and absorption are gastrointestinal system processes that supply nutrients to all cells within the body. Disruption within the GI could have effects that infiltrate other systems causing side effects outside of the digestive tract. By efficient and effective thorough documentation, the practitioner can account for all symptoms related to illness to determine possible disorder. By asking specific questions both subjectively and through visual assessment one can detect changes in function. The learner will critique a SOAP note and defend or refute the documentation with differential diagnoses.
Subjective Data
The data gathered on the patient is lacking essential information that could be used in the diagnosis of the patient’s symptoms. It is crucial to obtain a thorough history of the patient, family, and specific abdominal complaints by detailing characteristics about them to generate proper diagnosis (Jarvis, 2011). The history of present illness should incorporate data like onset, duration, characteristics, exacerbating, and alleviating symptoms as it relates to abdominal pain. Location is one of the most critical questions to ask before the beginning exam (Ball,2015). To reframe from exacerbating pain more, the practitioner should avoid palpating the area until the very end. This allows for a thorough assessment. Simple differentiation of sharp verses dulls generalized pain could signal the organs associated with the symptoms experienced (Dains, 2016). It is also critical to determine the characteristic of the other symptoms related to a stomach ache. The gastrointestinal disease usually manifests in the presences of at least one or more of the following: change in appetite, weight loss, dysphagia, nausea and vomiting, changes and bowel habits (2011).
In the subjective information provided the lack clarity in description of accompanying symptoms According to Ball, subjective assessment should include questions about diet including a 24hour history of meals, last bowel movement and characteristics thereof, recent travel history would also be useful information to note to account for suspected contracted GI disorders (Shaw, 2012). The family history of the patients seems to be completed; however, the patient’s personal history lacks detail. More information regarding his GI bleed would be a good place to start. Asking about whether it was an upper or lower GI bleed, diagnostics performed, results, medications used, complications, or the need for surgery and post-op care (2012). Comorbidities of the patient are also essential along with listed over the counter medications. Aspirins and the use of NSAIDs may cause abdominal pain and increase the likelihood of GI bleeds; therefore their application along with dietary supplements should be included within the report (Jarvis, 2011). Lifestyle risk factors are noted; however, the frequency and duration of alcohol consumpti.
A CASE REPORT ON CARBAMAZEPINE INDUCED STEVEN JOHNSON SYNDROMEJing Zang
Drug induced Steven Johnson Syndrome is reported with barbiturates, antibiotics, anticonvulsants, and NSAIDs. Among anticonvulsants the incidence of carbamazepine induced SJS is very low (0.25%). Here we report a case of Steven Johnson Syndrome late onset, induced by carbamazepine.
Priciples of therapeutics, Dosage Indiviualization, Herbal SupplimentsFarazaJaved
This presentation briefly covers the general aspect of therapeutics and drug development then its dose adjustment according to the pt. need and checking either patient comply to that therapy or not. last portion based on herbal supplements and its use.
This presentation discusses why weight loss is not just about calories. Hormones, Environment, Stress are just a few reasons weight management is so challenging
Quality use of medicines in geriatric patients with their Physiological changes with aging, altered Pharmacokinetics and Pharmacodynamics with ADR's, Guidelines for prescribing the older people and the role of clinical pharmacist in geriatric prescribing.
Good vehicle extrication demands a unique collaboration between rescue and emergency medical personnel. Incorporating key victim assessment information in the extrication size-up will improve your strategic and tactical plans. To save a patient (not just chop up a vehicle) rescue and EMS must understand each other’s’ jobs and work together effectively. This program uses a real-world approach to incorporate EMS care considerations in the extrication strategy and shows how most critical trauma encountered in vehicle collisions can be managed quickly and effectively by first re-sponders. This program will help you make better strategic extrication decisions and more safely deliver immediate life-saving treatment, reducing time from patient contact to patient removal to pa-tient surgery.
Prehospital Sepsis Research Update 2024 Rom DuckworthRommie Duckworth
Recently published papers have given us new insights into the next steps for prehospital care for sepsis patients. By looking at both macro and micro views of patient management this program presents our new understanding of the role of antibiotics, fluid administration, and coordination of clinical care as well as future tools, including advanced biomarkers and the application of antimicrobial nanotechnology. Arm yourself with indispensable knowledge to elevate your prehospital practice and make a real difference in patient outcomes.
Rommie L. Duckworth is a dedicated emergency responder, author, and educator from the United States with more than thirty years of experience working in fire departments, hospital healthcare systems, and private emergency medical services. Rom is a career fire captain and paramedic EMS Coordinator for Ridgefield (CT) Fire Department and director of the New England Center for Rescue and Emergency Medicine. Rom holds a master’s degree in public administration, is a graduate of the US National Fire Academy’s Executive Fire Officer program, and is the recipient of the NAEMT Presidential Award, American Red Cross Hero Award, Sepsis Alliance Sepsis Hero Award, and the EMS 10 Innovators Award for Sepsis Education. Rom is the author of "Duckworth on Education," as well as chapters in more than a dozen EMS, fire, rescue, and medical textbooks and over 100 published articles in fire and EMS magazines. A member of the NAEMT Board of Directors and the Sepsis Alliance Advisory Board Rom continues to work for the advancement of emergency services.
www.RomDuck.com
Running Head GASTROINTESTINAL TRACT1GASTROINTESTINAL TRACT3.docxjeanettehully
Running Head: GASTROINTESTINAL TRACT 1
GASTROINTESTINAL TRACT 3
GastroIntestinal Tract
Name
Institution
Course
Date
GastroIntestinal Disorders
Introduction
Normally, gastric acids are produced and stimulated so that the body can break down consumed foods and digest them easily. The major component of gastric juice is hydrochloric acid, which is produced by oxyntic cells. The secretion of these acids takes place in three phases namely: the cephalic phase, the gastric phase and the intestinal phase. The cephalic phase starts when someone has an urge to eat or smells food. The brain signals the parietal cells to secrete gastric acids and the ECL to secrete histamine. The gastric phase is when someone has eaten and the amino acids present in the food stimulates the production of these acids. The last phase is stimulated by the distention in the small intestines and the amino acids too and the secretion takes place when chime enters the small intestines (Testani et al., 1996).
Gastroesophageal Reflex Disease (GERD)
There are gastrointestinal orders that exist, such as Gastroesophageal Reflex Disease (GERD), Peptic Ulcer Disease (PUD) and Gastritis disorders. Patients suffering from GERD have a complex gastric acid secretion caused by frequent acid reflux. There are cases where HCL frequently flows back to the esophagus and when this happens, the lining of the esophagus becomes irritated. The age factor is visible in this disorder. Older people are more likely to experience this disease than young. However, symptoms are less visible in the elderly. The fact that there is no serious warning symptom of GERD among the elderly makes the disorder more complicated in them. GERD can be diagnosed by a probe test, upper endoscopy or x-ray of the upper digestive system. For the elderly, adequate doses of medication that do not harm the digestive system are effective. Medical therapeautic agents, including PPIs such as pantoprazole and Omeprazole, can also cure GERD.
Peptic Ulcer Disease (PUD)
PUD is caused by an imbalance between the secretion of gastric acid and duodenal mucous defence. When the balance between the two is disrupted, there is a consequence of mucousal injury and hence peptic ulcers. PUD among the elderly is associated by complications and when administering medication, special attention should be given to the elderly since they respond negatively to medications and surgery. PUD can be diagnosed by carrying out both physical and diagnostic tests (Okello, et. al, 2016) . Once it has been diagnosed, laboratory tests can then be undertaken such as breath tests, stool and blood tests. There are two main factors that contribute to the high rate of PUD among the elderly are the high rates of H. Pylori and prescription of drugs that increase damage in the gastroduodenal drugs. Elderly patients receive medical treatment of PUD
Gastritis Disorders
Gastritis disorders basically results from mucous injury that may have been caused by ...
Treasure, J., Claudino, A. M., & Zucker, N. (2010). Eating disorde.docxwillcoxjanay
Treasure, J., Claudino, A. M., & Zucker, N. (2010). Eating disorders. The Lancet, 375(9714), 583-93. Retrieved from http://search.proquest.com/docview/199059169?accountid=87314
Eating disorders
Treasure, Janet; Claudino, Angélica M; Zucker, Nancy.The Lancet375.9714 (Feb 13-Feb 19, 2010): 583-93.
Turn on hit highlighting for speaking browsers by selecting the Enter button
Show duplicate items from other databases
Abstract (summary)
TranslateAbstract
[...] binge eating disorder is often associated with obesity. Investigators of a study of a large sample of American children aged 9-14 years reported that 7.1% of boys and 13.4% of girls displayed disordered eating behaviours.35 The pivotal effect on health has led to the inclusion of eating disorders among the priority mental illnesses for children and adolescents identified by WHO.36 Eating disorders have been reported worldwide both in developed regions and emerging economies such as Brazil and China.37,38 The lifetime prevalence of eating disorders in adults is about 0.6% for anorexia nervosa, 1% for bulimia nervosa, and 3% for binge eating disorder.19,20 Women are more affected than are men, and the sex differences in lifetime prevalence in adults could be less substantial than that quoted in standard texts: 0.9% for anorexia nervosa, 1.5% for bulimia nervosa, and 3.5% for binge eating disorder in women; and 0.3%, 0.5%, and 2.0%, respectively, in men.20 Many people with eating disorders, who were detected in community studies in the USA, do not seek treatment.20 Pathogenesis A comprehensive review published in 2004 summarised the risk factors for eating disorders,39 and a position paper from the Academy of Eating Disorders outlined the evidence supporting these diseases as biologically-based forms of severe mental illnesses.40 In this section we draw attention to some present areas of emphasis.
Full Text
TranslateFull text
Headnote
This Seminar adds to the previous Lancet Seminar about eating disorders, published in 2003, with an emphasis on the biological contributions to illness onset and maintenance. The diagnostic criteria are in the process of review, and the probable four new categories are: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. These categories will also be broader than they were previously, which will affect the population prevalence; the present lifetime prevalence of all eating disorders is about 5%. Eating disorders can be associated with profound and protracted physical and psychosocial morbidity. The causal factors underpinning eating disorders have been clarified by understanding about the central control of appetite. Cultural, social, and interpersonal elements can trigger onset, and changes in neural networks can sustain the illness. Overall, apart from studies reporting pharmacological treatments for binge eating disorder, advances in treatment for adults have been scarce, other than interest in new f ...
Assessment of the Abdomen and Gastrointestinal SystemDigestion, .docxcargillfilberto
Assessment of the Abdomen and Gastrointestinal System
Digestion, motility, and absorption are gastrointestinal system processes that supply nutrients to all cells within the body. Disruption within the GI could have effects that infiltrate other systems causing side effects outside of the digestive tract. By efficient and effective thorough documentation, the practitioner can account for all symptoms related to illness to determine possible disorder. By asking specific questions both subjectively and through visual assessment one can detect changes in function. The learner will critique a SOAP note and defend or refute the documentation with differential diagnoses.
Subjective Data
The data gathered on the patient is lacking essential information that could be used in the diagnosis of the patient’s symptoms. It is crucial to obtain a thorough history of the patient, family, and specific abdominal complaints by detailing characteristics about them to generate proper diagnosis (Jarvis, 2011). The history of present illness should incorporate data like onset, duration, characteristics, exacerbating, and alleviating symptoms as it relates to abdominal pain. Location is one of the most critical questions to ask before the beginning exam (Ball,2015). To reframe from exacerbating pain more, the practitioner should avoid palpating the area until the very end. This allows for a thorough assessment. Simple differentiation of sharp verses dulls generalized pain could signal the organs associated with the symptoms experienced (Dains, 2016). It is also critical to determine the characteristic of the other symptoms related to a stomach ache. The gastrointestinal disease usually manifests in the presences of at least one or more of the following: change in appetite, weight loss, dysphagia, nausea and vomiting, changes and bowel habits (2011).
In the subjective information provided the lack clarity in description of accompanying symptoms According to Ball, subjective assessment should include questions about diet including a 24hour history of meals, last bowel movement and characteristics thereof, recent travel history would also be useful information to note to account for suspected contracted GI disorders (Shaw, 2012). The family history of the patients seems to be completed; however, the patient’s personal history lacks detail. More information regarding his GI bleed would be a good place to start. Asking about whether it was an upper or lower GI bleed, diagnostics performed, results, medications used, complications, or the need for surgery and post-op care (2012). Comorbidities of the patient are also essential along with listed over the counter medications. Aspirins and the use of NSAIDs may cause abdominal pain and increase the likelihood of GI bleeds; therefore their application along with dietary supplements should be included within the report (Jarvis, 2011). Lifestyle risk factors are noted; however, the frequency and duration of alcohol consumpti.
A CASE REPORT ON CARBAMAZEPINE INDUCED STEVEN JOHNSON SYNDROMEJing Zang
Drug induced Steven Johnson Syndrome is reported with barbiturates, antibiotics, anticonvulsants, and NSAIDs. Among anticonvulsants the incidence of carbamazepine induced SJS is very low (0.25%). Here we report a case of Steven Johnson Syndrome late onset, induced by carbamazepine.
Priciples of therapeutics, Dosage Indiviualization, Herbal SupplimentsFarazaJaved
This presentation briefly covers the general aspect of therapeutics and drug development then its dose adjustment according to the pt. need and checking either patient comply to that therapy or not. last portion based on herbal supplements and its use.
This presentation discusses why weight loss is not just about calories. Hormones, Environment, Stress are just a few reasons weight management is so challenging
Quality use of medicines in geriatric patients with their Physiological changes with aging, altered Pharmacokinetics and Pharmacodynamics with ADR's, Guidelines for prescribing the older people and the role of clinical pharmacist in geriatric prescribing.
Good vehicle extrication demands a unique collaboration between rescue and emergency medical personnel. Incorporating key victim assessment information in the extrication size-up will improve your strategic and tactical plans. To save a patient (not just chop up a vehicle) rescue and EMS must understand each other’s’ jobs and work together effectively. This program uses a real-world approach to incorporate EMS care considerations in the extrication strategy and shows how most critical trauma encountered in vehicle collisions can be managed quickly and effectively by first re-sponders. This program will help you make better strategic extrication decisions and more safely deliver immediate life-saving treatment, reducing time from patient contact to patient removal to pa-tient surgery.
Prehospital Sepsis Research Update 2024 Rom DuckworthRommie Duckworth
Recently published papers have given us new insights into the next steps for prehospital care for sepsis patients. By looking at both macro and micro views of patient management this program presents our new understanding of the role of antibiotics, fluid administration, and coordination of clinical care as well as future tools, including advanced biomarkers and the application of antimicrobial nanotechnology. Arm yourself with indispensable knowledge to elevate your prehospital practice and make a real difference in patient outcomes.
Rommie L. Duckworth is a dedicated emergency responder, author, and educator from the United States with more than thirty years of experience working in fire departments, hospital healthcare systems, and private emergency medical services. Rom is a career fire captain and paramedic EMS Coordinator for Ridgefield (CT) Fire Department and director of the New England Center for Rescue and Emergency Medicine. Rom holds a master’s degree in public administration, is a graduate of the US National Fire Academy’s Executive Fire Officer program, and is the recipient of the NAEMT Presidential Award, American Red Cross Hero Award, Sepsis Alliance Sepsis Hero Award, and the EMS 10 Innovators Award for Sepsis Education. Rom is the author of "Duckworth on Education," as well as chapters in more than a dozen EMS, fire, rescue, and medical textbooks and over 100 published articles in fire and EMS magazines. A member of the NAEMT Board of Directors and the Sepsis Alliance Advisory Board Rom continues to work for the advancement of emergency services.
www.RomDuck.com
While the popular myth is that everyone learns from experience, we all know people who can pass through experience without ever learning a thing. We now know that real learning comes from ef-fective reflection on real-life and simulated experiences. This session will provide you with the tools to use for effective reflection and enhanced learning from any situation. These include the learning models that lead to successful debriefing as well as the modified Plus Delta debrief format. These tools are crucial for any emergency services leader, educator, or provider for continuous per-formance improvement.
www.romduck.com
The Steps to Succession Planning Emergency ServicesRommie Duckworth
Identifying and preparing the next generation of leaders for your department is a critical responsi-bility. What will happen to all of the hard work you’ve put into your organization when it comes time for you to leave? Who will take your organization to the next level? Will they be ready to face the challenges that await them? Will they know how? Training your replacement takes work. Mak-ing a plan, finding a candidate, helping them develop, and handing off the reins isn’t just a good strategy; it is the only choice for your organization to survive. It can take time, money, and work and may seem counterintuitive to train people for a job they aren’t currently doing, but the “Train Your Replacement” mindset, and the four steps it requires, will help your organization get ready for the next set of challenges. This intensively participative workshop helps attendees evaluate their organization and themselves with the goal of “deepening the bench” of future emergency services leaders.
Teaching Formats:
-Lecture
-Question and Answer
Learning Objectives: At the conclusion of this program students will be able to:
- Utilize the “first steps-next steps-step up-step out” format of successful succession planning.
- Ask the key questions necessary to frame a succession plan or program.
- Outline the job requirements as they exist now and as they may exist 5 to 15 years into the leader-ship development process.
- Apply NFPA 1020 or NEMSMA 7 Pillars to leadership development in their organization.
- Link job performance requirements to knowledge, skills, and attitude requirements for positions that will need to be filled.
To think of stroke as a life or death situation is to over-simplify. The concept of “Time Is Brain” doesn’t refer to inanimate neurons that die as a stroke progresses. Each moment of delay in stroke care can destroy not only a patient’s ability to perform activities to get through the day can also lose cells that contain personality and memories. Even patients who survive may lose part of their life. As hospitals are developing new methods of treatment for stroke victims, what role is there for EMS? This program will examine new in-hospital treatments like site-specific thrombolytics, clot corkscrews, cranial hypothermia, and the critical role of EMS in each phase of Stroke Systems of Care. These systems rely on both ALS and BLS providers to not simply save patients’ lives. This lively, pertinent, and through-provoking lecture shows how the actions of EMS providers are critical to every step of saving stroke patients’ life’s.
www.ROMDUCK.com
This program can help you answer the following ques-tions about UAVs and fire department operations
• How can sUAS be used to enhance emergency and non-emergency fire department operations?
• How do federal, state, and local laws and regulations impact fire de-partment use of sUAS?
• What are the potential costs of using SUASs in fire department opera-tions?
• What are the political, social, and other non-regulatory considerations of using sUAS in fire department operations?
Presented by Capt. Rommie L. Duckworth, MPA, LP, EFO
Ridgefield (CT) Fire Department
What they didn't tell you about Anaphylaxis 2023.pptxRommie Duckworth
What’s the difference between anaphylactic and anaphylactoid, and should I care? Can a patient have a life-threatening reaction on a first exposure? What are the most important ALS medications for anaphylaxis after epinephrine? How bad is it to give epinephrine for a panic attack? What the heck is Kounis syndrome? Why didn't they teach me this in class? The past ten years have seen a dramatic increase in the number of cases of anaphylaxis across the United States. In response, the American College of Emergency Physicians and the World Allergy Organization have issued im-portant updates on initial emergency treatment for patients suffering from anaphylaxis. While epi-nephrine remains the front-line drug for all levels of care, recent studies show that in-hospital and pre-hospital providers alike aren’t giving it as often or as early as they should. This interactive case-study and pub-quiz style presentation answers these questions and many more with a focus on a rapid differential of anaphylaxis and effective initial and secondary treatments to manage these immediately life-threatening emergencies.
Catch Them and Keep Them: Recruiting and retaining top employees and volunteersRommie Duckworth
Work in any organization, large or small, paid or volunteer, involves transactions of value where the member gets value from the organization and gives value back. Volunteer and employment ex-changes have traditionally focused on the perspective of the organization and what they could get from members. Today, leaders must flip that perspective and consider what the member is looking to gain rather than just what the organization is willing to give to the employee or volunteer. Getting this "employee value proposition" right can help organizations attract high-quality candidates, engage current members to boost performance, and improve the customer experience and business operations. With quality EMS candidates and providers at a premium, organizations that can provide good employee value propositions will thrive, and those that do not will fail to survive.
The Top 10 Resuscitation Headlines and Controversies: And How To Read Past Th...Rommie Duckworth
We’ve all heard controversies about cardiac resuscitation. “Use the right medications.”, “Medications don’t matter.”, “Airway first!”, “Don’t worry about the airway!” It is confusing for EMS professionals to sort out exactly what they’re supposed to do. Taking a look at the Top Ten Headlines for cardiac resuscitation, this program evaluates the strength of the science behind each recommendation as well as how they might be implemented in different EMS systems. Getting past the “Headlines,” attendees will return home well-equipped to open up discussions about optimizing EMS cardiac arrest resuscitation in their systems beyond “I read this study once” or “This is what the algorithms say now.”
The Top 10 Trauma Myths and Legends: Seeking the science beyond the textbooksRommie Duckworth
We’ve all heard the legends of trauma care. “ABCs vs. CABs!”, “Mechanism of Injury Matters!”, “Never remove a dressing!”, “Hyperventilate that head injury!” But what happens when what you were taught no longer matches what science says? Taking a look at the Top Ten Trauma Myths and Legends, this program evaluates the strength of the science behind each recommendation as well as how they might be implemented in different EMS systems. Getting past “we’ve always done it this way,” attendees will return home well-equipped to open up discussions about trauma care in their systems beyond, “This is what I was taught in class.” and “I read this study once.”
Vince Lombardi said, “The quality of a person’s life is in direct proportion to their commitment to excellence.” In our work, the quality of the lives of others is also in direct proportion to our commitment to excellence. So, if we have all agreed to work in the service of others in their time of need, why do some people in emergency services only go as far as “good enough”? How do people slide from doing what’s right to doing what’s “good enough,” and how do we reconnect them to a commitment to excellence? Inspiring and informative, Rom Duckworth shows how easy it can be for organizations and individuals to stray from the path of excellence and reminds us of the importance of what we do and why, in our unique profession, good enough is simply not good enough.
www.RomDuck.com
Prehospital traumatic cardiac arrest is relatively rare and highly complex event that will challenge even the most skilled providers and resuscitation teams. This is further complicated by a shortfall of clear consensus guidelines to help EMS providers rapidly identify, assess, prioritize and care for underlying life-threats as they simultaneously work to resuscitate the patient. What is the best bal-ance between simple algorithms that focus on core priorities versus critical think-ing recommendations that address issues more specifically? This session looks at the latest research and guidelines from key organizations such as the National Association of EMS Physicians, American College of Surgeons Committee on Trauma, and the American Heart Association as well as similar organizations from around the world to help us make the best decisions and take rapid action to give our patients the best hope of survival. Find more at www.RomDuck.com
Sepsis is an emergent medical condition that kills more people annually than prostate cancer, breast cancer, and AIDS combined. For every two heart attack patients cared for by EMS, five patients are hospitalized by sepsis. EMS transports 60% of patients with severe sepsis arriving at the ED and yet EMS providers are often unaware of its presence or what they should do if they find it. This presentation discusses new sepsis criteria along with expert commentary as to how they can be applied in the field. This program includes real-world, practical methods for EMS identification, assessment and field treatment of life-threatening sepsis and looks at the current state of sepsis critical care as well as what we can anticipate in the coming months and years.
In the United States each year approximately 75,00 children develop severe sepsis, ap-proximately 6,800 of whom will die. Many of these cases may include missed or delayed diagnosis. As an EMS provider you play a decisive role in the identification and early treatment of these critically ill children. This program will show EMS providers how to identify, assess, and begin treatment for pediatric patients with sepsis as well as how to coordinate care with emergency department and critical care staff. This program is in-tended for both advanced and basic providers whether working or not your EMS system currently has formal sepsis alert protocols. Learn the latest updates and take home the knowledge of how you can make the biggest difference for our littlest patients.
For more information go to www.RomDuck.com
The Top 10 Resuscitation Headlines and Controversies: And How To Read Past Th...Rommie Duckworth
We’ve all heard the controversies for cardiac resuscitation. “Use the right medications.”, “Medications don’t matter.”, “Airway first!”, “Don’t worry about the airway!” It is confus-ing for EMS professionals to sort out exactly what they’re supposed to do. Taking a look at the Top Ten Headlines for cardiac resuscitation this program evaluates the strength of the science behind each recommendation as well as how they might be implemented in dif-ferent EMS systems. Getting past the “Headlines”, attendees will return home well-equipped to open up discussions about optimizing EMS cardiac arrest resuscitation in their systems beyond “I read this study once” or “This is what the algorithms say now.”
It is a tremendous challenge to deliver quality emergency services education. The hurdles that have to be overcome by program directors and individual educators to meet objectives and help students achieve competencies can be discouraging at best. That's why we have to stick together. Here is a treasure-trove of top-tips for educators.
It is a tremendous challenge to deliver quality emergency services education. The hurdles that have to be overcome by program directors and individual educators to meet objectives and help students achieve competencies can be discouraging at best. That's why we have to stick together. Here is a treasure-trove of top-tips for educators.
Putting hands on teamwork back in your classroom ssRommie Duckworth
As a profession, emergency services is nearly unique in it’s demands for providers to be able to act as both coordinated team members and independent operators. Critical concepts such as group dynamics, teambuilding, leadership, followership, and interpersonal communications can be difficult to introduce in cognitive and affective domains, let alone practice as psychomotor skills. While there are plenty of “Get out of your seat” activities out there, many of them entertain and fill time, but few focus on teaching and evaluating team-based competencies. Featuring fifteen exercises that you can bring back to your EMS classroom today this program will help you help your students work together better both in the classroom and on the street.
Social Media Policies and Practices for Emergency ServicesRommie Duckworth
The proliferation of social media and mobile technology is creating new challenges for emergency responders. On virtually every call smart phones, helmet cams and more are capturing images and information ready to be uploaded and shared with the world. New questions of personal privacy and freedom of speech for responders using social media off-duty need to be addressed. How do agencies navigate the minefield that is the new social media landscape? This program gives emergency services leaders and providers plenty of take-home resources to create or revise their social media policies and practices including the twenty points that need to be addressed in any guiding social media documents and ten recommendations for responsible social media use by responders.
www.RescueDigest.com
wwwRomDuck.com
Competency Based Education for Emergency ServicesRommie Duckworth
Recall of information is simply not good enough. For students to be capable of practical problem solving and skills performance, their educators must insist on using competency based principles of education. Through a combination of educational methods and resources, pacing learning to student performance, providing frequent feedback, and connecting foundational information with real-world performance, it has been proven that students will leave the classroom not just more ready for the test, but more ready for the street. This program will help EMS Educators better implement the competency-based National Education Standards crucial for students to complete their programs and emerge as true healthcare professionals, new, but street-ready providers, and lifelong learners.
www.RescueDigest.com
www.RomDuck.com
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Performance Standards for Antimicrobial Susceptibility Testing
Duckworth Designer Drugs.pptx
1.
2.
3. V
8/21/2019
Johnson, E. (2019, July 11). Preliminary 2018 data shows decline in opioid deaths. Austin Daily Herald. https://www.austindailyherald.com/2019/07/preliminary-2018-data-shows-decline-in-opioid-deaths/
4. 9/21/2021
Center for Disease Control and Prevention. (2021). HAN Archive—00438 | Health Alert Network (HAN). Center for Disease Control and Prevention. https://emergency.cdc.gov/han/2020/han00438.asp
6. Center for Disease Control and Prevention. (2023, August 8). Understanding the Opioid Overdose Epidemic | Opioids | CDC. https://www.cdc.gov/opioids/basics/epidemic.html
7.
8.
9. Bhullar, M. K., 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. Bhullar, M. K., 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. https://doi.org/10.1016/j.dadr.2022.100069
11.
12. The
Problem
A critical threat to
Patient Families Community
EMS
• Physical
• Burnout
• Addiction
A continued overdose
epidemic born on the backs
of EMS
13. The Goal
Better understanding of designer/synthetic drugs
Improved short-term incident management strategies
Improved long-term care innovation
27. Designer Drugs
What are 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?
34. Often sold in 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
37. (ACEP recognizes the 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. These patients are 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. The goal when 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.
42. Super Meth
2006: Ephedrine and pseudoephedrine moved
behind pharmacy counter
P2P methamphetamine: intense, long-lasting highs
Extreme aggression and paranoia
43.
44.
45. 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. 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.
60. Cannabinoid Hyperemesis Syndrome
First 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. https://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. https://doi.org/10.1007/s13181-016-0595-z
61. Medical emergencies related 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. https://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. Prodromal Phase
Mild discomfort 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/
63. Hyperemetic Phase
Nausea, vomiting, 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/
64. Recovery Phase
Can last 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/
65. Assessment
History of present injury including
syndromic presentation
Past medical history including marijuana
use
A physical exam
Vital signs
Capillary blood glucose check
12 lead EKG
66. Assessment
Complications from chemotherapy
Bowel 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. https://doi.org/10.1007/s13181-016-0595-z
67. Assessment
Most common complications
• 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. Supportive
Treatment
Avoid narcotic pain 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. https://doi.org/10.1007/s13181-016-0595-z
69. Supportive
Treatment
Patients with moderate 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. https://doi.org/10.1007/s13181-016-0595-z
70. Supportive Treatment
• Chu, F., & Cascella, M. (2023). Cannabinoid Hyperemesis Syndrome. In
StatPearls. StatPearls Publishing.
http://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.
https://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. https://doi.org/10.1007/s13181-016-0595-z
71. CHS: Take Home
Emergency 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. https://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.
https://doi.org/10.1016/j.jemermed.2012.11.034
78. Isotonitazene
(ISO)
Nitazines in powder 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).
82. Innovative EMS Strategies
ASTHO. (2021). Innovations in Overdose Response: Strategies Implemented by Emergency Medical Services Providers.
83. Among the 143 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. https://doi.org/10.1080/10903127.2020.1771490
84. Buprenorphine
Bridge Program
Buprenorphine or 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. https://doi.org/10.1080/10903127.2022.2061661
85.
86. The
Problem
A critical threat to
Patient Families Community
EMS
• Physical
• Burnout
• Addiction
A continued overdose
epidemic born on the backs
of EMS
87. The Goal
Better understanding of designer/synthetic drugs
Improved short-term incident management strategies
Improved long-term care innovation
Johnson, E. (2019, July 11). Preliminary 2018 data shows decline in opioid deaths. Austin Daily Herald. https://www.austindailyherald.com/2019/07/preliminary-2018-data-shows-decline-in-opioid-deaths/
It started in the mid-1990s when the powerful agent OxyContin, promoted by Purdue Pharma and approved by the Food and Drug Administration (FDA), triggered the first wave of deaths linked to use of legal prescription opioids. Then came a second wave of deaths from a heroin market that expanded to attract already addicted people. More recently, a third wave of deaths has arisen from illegal synthetic opioids like fentanyl.
Center for Disease Control and Prevention. (2023, August 8). Understanding the Opioid Overdose Epidemic | Opioids | CDC. https://www.cdc.gov/opioids/basics/epidemic.html
Still difficult to test for in most facilities.
The use of antipsychotic agents for the treatment of hypoactive delirium as routine practice is controversial. Most clinicians refrain from administering antipsychotics unless an additional indication warrants their use, including agitation, hallucinations, or delusional thought content, as mentioned earlier. Importantly, it is best to avoid polypharmacy and to avoid starting new deliriogenic agents (e.g., benzodiazepines and anticholinergic agents) to the extent possible.
Administering buprenorphine to overdose patients within 10 minutes after resuscitation quickly alleviates withdrawal symptoms and results in a nearly six-fold increase in patients showing up for treatment within 30 days