Seizure + Hypoglycemia + Opioid Toxicity Flashcards
Treat and Dischrage Medical Directives
What is the IDEAL mnemonic?
What should you do if you are unclear if the patient meets all of the discharge criteria?
INCLUDE the patient and family as full partners
DISCUSS with the patient and family key areas to prevent problems
EDUCATE the patient and family in plain language
ASSESS the patient’s understanding
LISTEN to the patient’s goals, preferences, observations, and concerns
Patch to BHP for a consultation.
Seizure Medical Directive - AUXILIARY
What are the first 7 considerations criteria for treat and discharge?
What are the 5 AND criteria the patient needs to meet for treat and discharge?
The patient is ≥ 18 and <65 years old
Pt must have a history of epilepsy
The pt is taking their anticonvulsant medications as prescribed
The pt must have only had a single seizure episode in the past 24h
The seizure pattern and duration must be similar to past seizures
The pt has returrned to their normal level of consciousness
A complete set of vital signs including temp are within expected normal ranges
The seizure must not be related to hypoglycemia, alcohol, or substance abuse or withdrawal
The pt must not have received midazolam by paramedics
The pt did not injure themselves during seizure activity
The pt must not have a fever, preceding illness or recently started new medications
The pt is not pregnant
Seizure Medical Directive - AUXILIARY
What are the 6 requirements that must be met for the paramedics to discharge?
A responsible adult agrees to remain with the patient for the next 4 hours
All of the patient or substitute decision makers questions were answered, and a care plan was developed
The patient or SDM has been advised to follow up with their primary health care team or provider
Clear instructions to call 911 were provided should symptoms redevelop
Patient or SDM has the ability to access 911 should symptoms redevelop
Patient or SDM consents to the discharge
Seizure Medical Directive - AUXILIARY
What does a confirmed hx of epilepsy mean?
What does new medication refer to with regards to seizures?
Means diagnosed by a physician
The addition of new or changes to anti-seizure medications (dosage or type) in the past 30 days should be considered as they can potentially lower a patient’s seizure threshold
Seizure Medical Directive - AUXILIARY
What is a seizure cluster?
multiple seizures that occur within a 24 hour period
Opioid Toxicity and Withdrawal Medical Directive
What are the INDICATIONS?
What is Buprenorphine/naloxone (Suboxone)?
What is naloxone/narcan?
Suspected opioid toxicity
mixed opioid agonist-antagonist used for opioid withdrawal symptoms
non-specific + competitive opioid receptor antagonist metabolized in the liver
Opioid Toxicity and Withdrawal Medical Directive
What are the CONDITIONS for Naloxone?
What are the CONTRAINDICATIONS?
GREATER/EQUAL to 24h old
Altered LOA
LESS than 10 breaths/min
Inability to adequetely ventilate
OR
persistant need to assist ventilations
Allergy or sensitivity to naloxone
Opioid Toxicity and Withdrawal Medical Directive
Why is IV use preferred 1st for naloxone?
Can you make a judgment call on the route of naloxone?
What are aloquotes? - are they considered a dose?
Because you can titrate i.e. administer slowly
Yes - sometimes IN is better
They are smaller doses compared to the standard/desired dose - it is considered a full dose once they accumulate to meet it
Opioid Toxicity and Withdrawal Medical Directive
What should you do if the pt was administered naloxone before your arrival?
The timing interval is 20min so you should wait and vetilate the pt based on their timing of the naloxone administration. If the patient isn’t improving then administer.
Opioid Toxicity and Withdrawal Medical Directive
What are the CONDITIONS for Buprenorphine/naloxone?
What are the CONTRAINDICATIONS?
GREATER/EQUAL to 16y/old
Unaltered LOA
Pt has received naloxone for current opioid toxicity episode
AND
Patient is exhibiting acute withdrawal with a COWS score ≥ 8
Allergy or sensitivity to buprenorphine
Taken methadone in the past 72 hours
Opioid Toxicity and Withdrawal Medical Directive
What is the preferred ROUTES and TREATMENT PLAN for Naloxone?
Who does the administration of IV naloxone apply to?
What is the IV route ONLY used for?
ROUTE - IV
Dose - up to 0.4mg
Max. Single Dose - 0.4mg
Dosing Interval - 5min
Max # of Doses - 3
ROUTE - IM
Dose - 0.4mg
Max. Single Dose - 0.4mg
Dosing Interval - 5min
Max # of Doses - 3
ROUTE - IN
Dose - 2-4mg
Max. Single Dose - 2-4mg
Dosing Interval - 5min
Max # of Doses - 3
ROUTE - SC
Dose - 0.8mg
Max. Single Dose - 0.8mg
Dosing Interval - 5min
Max # of Doses - 3
PCPs authorized for PCP autonomous IV
to restore the patient’s respiratory status
Opioid Toxicity and Withdrawal Medical Directive
What is the ROUTE and TREATMENT PLAN for Buprenorphine/Naloxone?
What is paramount and the initial priority in this medical directive?
What do you do if the patient shows no response to the initial treatment?
ROUTE - PO
Initial Dose - 16mg
Subsequent Dose(s) - 8mg
Dosing Interval - 10minutes
Max culmative Doses - 24mg (2 total)
Upfront aggressive managemet of the airway
Consider patching for futher doses
Opioid Toxicity and Withdrawal Medical Directive
When should you consider glucometry (BGL)?
What should you anticipate about the administration of naloxone?
What are the desired clinical effects for titrating IV naloxone?
If the patient does not respond to airway management and the administration of naloxone!
The pt may show combative behaviour and you should protect yourselves
RR GREATER/EQUAL to 10 breaths/min
Adequate airway and ventilation
not full alertness
Opioid Toxicity and Withdrawal Medical Directive
What’s preferred over naloxone if available?
Does naloxone completely correct an opioid overdose?
BVM and basic airway management
Naloxone is shorter acting than most narcotics and these patients are at high risk of having a recurrence of their narcotic effect.
Every effort should be made to transport the patient to the closest appropriate receiving facility for ongoing monitoring
Opioid Toxicity and Withdrawal Medical Directive
Why is the age limit now GREATER/EQUAL to 24h old.
What alternative toxidromes could be unmasked from naloxone?
Because it’s to minimize the risk of life threatening opioid withdrawal syndrome in the newborn
seizures
Hypertensive crisis
Opioid Toxicity and Withdrawal Medical Directive
Show me the COWS Scale
what are the categories?
When do the Signs and Symptoms show up/when should you assess them?
Resting pulse rate
Restlessness
Runny nose or tearing
Sweating
Tremor
GI Upset
Yawning
Bone or joint aches
Gooseflesh Skin
Pupil Size
Anxiety or irritability
30min after administration of naloxone
