Naloxone sold over the counter? An article in the San Francisco Chronicle today talked about a new bill that would make the "overdose antidote easier to buy." AB1535 would allow naloxone (brand name Narcan) to be sold without a prescription in California. The idea is to more quickly treat patients of opioid overdoses before they die.
The most common serious opioid overdoses come from heroin, which is a narcotic deemed to have no medicinal use according to the DEA. While heroin might not be medicinal, its cousins are. You might've heard of a few of them: Oxycontin, Vicodin, Norco, methadone, morphine, Percodan, Percocet, Darvon, Darvocet...
The list goes on.
When one overdoses on these opioids, breathing can stop. There are some other physiological signs, but the lack of breathing really gets in the way of living a full and meaningful life. Not every opioid overdose patient stops breathing, but those who do stop often don't start again.
Naloxone makes one breathe again.
It's pretty dramatic. A few seconds after receiving naloxone by injection, overdose patients take a deep breath and wake up, usually with protests of "I didn't take anything" or "I only had a few drinks." For future reference: alcohol kills in a completely different way and naloxone absolutely only works on opioids. It doesn't do jack for anything else.
And therein lies my only concern with this plan.
I don't see a ton of issues with a naloxone autoinjector lying around here and there for the heroin overdose patients to try. Indeed, these folks are professionals and so are their friends. It's entirely probable that they would be able to recognize and reverse the overdose with naloxone.
I am a little concerned about the other use mentioned in the article: prescription overdoses. People who use the medicines I listed above or any of the other countless derivatives might try to have a dose of naloxone around the house just in case. It's not that big of a deal if they're right. Naloxone would certainly fix the problem.
But folks who take these medications rarely take only these medications. And remember: naloxone doesn't do squat for anything that's not an opioid, even the stuff that's mixed with the opioids. Naloxone won't fix the acetaminophen overdose that goes with the Vicodin overdose, even though it will reverse the Vicodin. Once the Vicodin is gone, the acetaminophen will still kill the patient.
Sedatives that aren't opioids won't be reversed, either. So if valium, ambien, alcohol or carisoprodol are the drugs causing the patient not to wake up, giving naloxone will only stall real help.
The article suggests there are only two options: take naloxone immediately at home or wait until the ER, where it might be too late. I suggest there's a third option: Call 911. Ambulances carry naloxone. They have for decades. And, paramedics are trained to recognize the signs and symptoms of an opioid overdose. If the issue is not a opioid overdose, they'll recognize that, too.
And they won't waste time trying naloxone when it's something else, like a stroke.
We teach kids not to get in a car with strangers. We teach them how to answer the door -- or not to -- when we're not home. We teach them to look both ways before crossing the street. We teach them not to play with matches.
That's good, but it's not enough. Your kids need to know more about safety.
What if they do play with matches? Do your kids know what to do if they catch their clothes on fire or burn themselves?
Part of growing up is becoming more independent. Your teenagers probably have cell phones. One of the reasons you purchased it for them was for safety. Did you know there's a difference between calling 911 on a cell phone and calling 911 from your house phone? Your kids need to know what to expect when they dial 911 from their cell phone -- and what will be expected of them.
They should know how to Stop, Drop and Roll if their clothes catch fire and how to treat the burns.
Small kids should know how to protect themselves from stray dogs. Bigger kids are strong enough to do CPR.
Teaching kids to avoid strangers and look both ways are both good starts on being safe, but kids can and should learn a lot more. Empower your youngster to be independent and respond to dangers quickly and decisively. They might even save you some day.
Anemia is a medical condition related to the lack of a component of blood. In most cases, it's from an iron deficiency. Iron is essential for the body to metabolize oxygen. If you don't have enough, you can't use all the oxygen you inhale.
Iron deficiency also leads to difficulty of creating clots, which means that people with anemia bleed and bruise more than healthy patients.
Anemia can be treated with iron supplements, but only if it's diagnosed. It's important to tell your doctor if you're feeling tired, bruising easily or feeling short of breath for no obvious reason.
News accounts of burn injuries almost always include statements like "more than 30 percent of his body was covered in third degree burns."
What does that mean, exactly?
Burns are complicated. Burn injuries come from lots of different causes: heat, chemicals and the sun are the most common. Regardless of the cause, burns are almost exclusively injuries to the skin.
Determining the extent of a burn injury requires knowing two things: how deep the burn goes and how much of the skin is affected. Figuring out the amount of skin (called the body's surface area or BSA) can be a convoluted process and we'll save that discussion for another day.
Burn depth, on the other hand, is easier to understand and to identify. Skin consists essentially of three layers:
- Epidermis is the outer layer of dying or dead skin cells that provides a barrier to moisture and infection.
- Dermis is the main layer of raw skin that contains all of the parts we associate with skin: hair follicles, nerve endings, sweat and oil glands, etc.
- Subcutaneous is not really skin but is a thin layer of fat tissue we all have, no matter how skinny we are (or aren't).
Burn depth refers to how much of each layer is either damaged or destroyed.
- First degree burns: the top layer (epidermis) is only damaged. The skin turns red, but it stays whole and intact. First degree burns are also known as superficial burns.
- Second degree burns: the middle layer (dermis) is damaged and begins to swell. The epidermis is damaged bad enough to separate from the dermis, which leads to blisters and sometimes leads to the epidermis coming off and leaving raw, weeping skin. Second degree burns are also known as partial thickness burns.
- Third degree burns: the epidermis and dermis are completely destroyed, leaving dead, sometimes charred, tissue behind. The damage extends all the way down to the subcutaneous fat. Third degree burns are also known as full thickness burns.
So, the next time you see a blister after a burn, you'll know you're seeing a second degree, partial thickness burn.
- 10 Examples of Second Degree Burns
- Assessing Burns
- How to Treat a Burn
- Video: Treating a Burn
- Video: Degrees of Burn
First Aid Phraseology is an occasional look at the common words and phrases used in first aid and emergency medical services. Have a term you'd like to know more about? Email me and I'll touch on it in a future post.
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The spiders are coming out.
It's almost spring and as it warms up it becomes perfect spidey weather. The little 8-legged monsters are lurking under every woodpile and old tire just waiting for a chance to nibble on your nether regions.
Will you know?
Some folks report feeling a little pinprick. Others say they felt nothing at all. Many just show up to the emergency department with their skin rotting off.
Don't wait too long before you get help. Spider bites are real problems, but many wounds blamed on spiders aren't from arachnids at all. There aren't too many spiders known to leave massive wounds. The brown recluse is the best known for its nasty bite, but most of the disgusting, infected sores attributed to the recluse probably didn't come from a spider at all.
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There are reports that 176 people are missing after a landslide in Oso, Washington. In press conferences today, officials tried to clear up a misunderstanding: there aren't necessarily 176 missing persons, but there have been 176 reports of missing persons.
This is a great example of how important it is to have a public information officer (PIO) who is a professional. An experienced PIO would've vetted the information before releasing it. Officials should have reconciled the reports to identify how many actual missing persons they were dealing with before releasing anything.
They didn't have to give a number. They could have simply said there were reports of several missing persons and cleared it up later. Now we're spending time on the number instead of the point.
In the grand scheme of things, the number of possible missing persons or getting information to the media isn't as important as responding to the crisis. As far as I can tell, officials are doing as good a job as they possibly can. This is just an example of how difficult it is to balance the desire of the public to know what's happening with the needs of the response.
Basically, the PIO is not too different from the reporters he or she is responsible for briefing. In an emergency operations center, the care and feeding of the PIO is not always at the top of the priority list. That changes when authorities need the public to do something specific, but usually the PIO has to ask the operational side of the house for updates. It is quite conceivable that someone told the PIO in Washington that there were as many as 176 missing persons and that number made it into the media.
Medical terminology has all kinds of odd words that may seem to the layperson to be complete nonsense. While some of the terms are certainly not mainstream (proximal, medial and mandibular all spring to mind), the fact that each word has its very specific meaning is necessary so that all healthcare providers understand each other.
Superior and inferior are two of my favorites. I like these because they have totally different meanings in nonmedical life. In most cases, superior is vastly...well...superior to its counterpart. It's the better product or the better service. Superior is one of the boxes you check on those internet surveys you fill out when you're trying to get a free coffee.
Inferior is an insult. It's the ground level, the worst case scenario. Nobody wants to feel inferior. Indeed, it even has its own condition: the inferiority complex. Inferior objects are beneath the superior ones.
And that's how it connects to medical terminology. Read More...
So, the good news is that I finally found a great place to live literally across the street from the ocean. The bad news is: it's falling in.
My wife and I have always wanted to live near the water. I wanted a water view--and I have one, if you count sticking your head sideways into the window box in the kitchen--and I wanted to hear the waves. I got what I'd always hoped for, but unfortunately it won't be here forever.
I know that's kind of a silly thing to say. We all know that buildings get old and landscapes change. New York City is layered like an onion from all the building that's happened there. Even San Francisco, just a few miles from my new abode, looks a lot different today than it did during the Gold Rush years.
But in this case I mean it won't be here by the time my kids are retiring. The bluffs are falling into the ocean. Quickly.
For as long as I can remember, California falling into the ocean has been a running joke. The gag is usually that we'll just go under one day as a result of a giant earthquake. Luckily for us, it doesn't quite happen that way.
What does happen is that rainfall soaks into the soft soils of the earth here. Those soft soils are beautiful and overlook the crashing waves of the ocean, which also eat at them from underneath. People build homes on the tops of these soaked, soft, shaky bluffs and wonder what happened when the excess weight causes them to crumble.
It's happening in Malibu, which gets plenty of media attention because of the magnitude (and cost) of the homes. But Malibu isn't the only place where the cliffs are falling and taking manmade structures with them. In Pacifica, California there was a street that collapsed into the water and a few apartment buildings were declared unfit for human habitation when their backyards went swimming.
Don't get me wrong, if a major earthquake happens, there will be more collapsing. I'm far enough away from the edge to be safe, but if the unthinkable does happen, I could truly have that water view I was looking for--right out my living room wall.
I live in California. As you may or may not have heard, we have a tendency to shake out here. Big earthquakes can be kind of scary when you take time to think about them, but we hardly ever do. Most of the time we just go about our business and every once in a while we hear that San-something-or-other had a five-point-whatever quake last night around midnight. Occasionally, we get a doozy.
It's no different in other parts of the country, but we must get used to our own brand of disaster. I laughed out loud when in Mississippi -- after hurricane Katrina -- a patient I was treating asked where I was from.
"California," I said, with an air of pride in my voice.
"Oh goodness," came the reply. "I don't know how y'all can live out there with them earthquakes."
Storms don't have to have names for them to be a big deal. Tornado alley cranks up a show every year like clockwork and lightning does a pretty good job of setting the western states on fire whether the weather is more el Niño or la Niña. Superstorm Sandy--part named storm and part Frankenstein's monster--shut down New York in October of 2012. Floods occur somewhere just about every month of the year.
Mother Nature doesn't even have to put the hammer down for us to run into trouble; a simple power failure can be devastating.
Wherever you live, it's a good idea to be prepared in the case of disaster. At a minimum, it's recommended to have at least 3 days worth of supplies on hand in case the grocery store gets demolished. Since the drug store might take even longer to get back in the game, you should have at least a week's worth of medications.
- Disaster Preparedness
- Off the Shelf Emergency Kits: Just Add Water
- How much water is enough?
- Surviving Disasters Without Preparing
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I've always advised against seeing your doctor when you have chest pain, just in case it could be a heart attack. Seeing your doctor is an unnecessary delay. Chest pain should always go first to the emergency room -- preferably by ambulance.
Two studies in 2008 confirmed that calling your doctor with stroke symptoms may delay treatment. The treatment that can possibly reverse the symptoms has to be started within 3 hours of the first symptoms.
In one study, conducted in West Virginia, researchers randomly called doctors' offices and described stroke symptoms. Nearly a third of all the receptionists suggested a wait-and-see response. They advised the callers to call back if symptoms persisted. What they should have done was tell the caller to hang up and dial 911.
Another study in Australia looked at almost 200 stroke patients in 3 different hospitals. The patients were asked if they contacted their primary physicians before coming to the hospital. About a fifth of the patients called the doctor before going to the hospital. Of those who called the doc, less than half were told to call an ambulance; and even though they were correctly told to call, the extra step of calling the doctor delayed their care by an average of 92 minutes. That's a lot of time when you only get a 3 hour window.
Of course, that delay is nothing compared to the more than 7 hours it took for the wait-and-see crowd to get to the emergency department. If the doc suggests that you wait or schedules an appointment for you later today or tomorrow, the chance of treating your stroke and reversing some of the symptoms simply vanishes.
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause.