Ordering Narcan Nasal Spray into Canada (June 3, 2016) and developing a fridge magnet together with Methadone Medical Alert tag would be evidence of Clinical LEADERSHIP.
Position Statement. Opioid DETOXIFICATION is a DEADLY practice as the dead people are finding out through first-hand experience. Click to view PDF
Signs and Symptoms Of Methadone/Opiate OVERDOSE
- Pinpoint pupils
- Nausea & vomiting yellow bile
- Dizziness
- Feeling Intoxicated
- Sedation/nodding off
- Unsteady gait/ slurred speech
- Loud snoring, grunting, groaning,
- Clenched teeth
- Hypotension (low blood pressure)
- Slow pulse (bradycardia)
- Shallow breathing (hypoventilation)
- Frothing at the mouth
- Coma/loss of consciousness
Methadone Medical Alert
Treatment
- Activate 9-1-1
- Give Narcan Nasal Spray
- CPR – rescue breathing, chest compressions, attach automated external defibrillator (AED) or external pacemaker
*Do not taser – see Mathew Hines video-taped death
*Made in Canada, eh! Let it Snow!*
www.crystalcleartransitionalcare.com
#Nasalspray
** see Narcan Nasal Spray Teaching video
https://vimeo.com/269917572/be3c2aa243
Leadership:
- Development of an extubation checklist using new evidence
Revised 08/19 |
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Extubation Checklist |
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Patient’s Age: Gender: M / F |
Patient’s Weight = |
Indicate |
Value/Comment |
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Reason for Intubation: Circle |
Trauma/COPD/Asthma/Head Injury/Opiate overdose (other) |
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High Risk Extubation?
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Neck Surgery |
Yes
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No |
If yes, consider removal in O.R. |
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Pre-extubation tests |
Airleak test Chest x-ray (Opiate?, A, B, C, D…) CT Scan MRI Echocardiogram/ECG Other – state (3T MRI, etc.) |
Yes Yes Yes Yes Yes Yes |
No No No No No No |
Pass/Fail |
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Patient Assessment |
Awake Follows commands Agitated Cooperative Muscle relaxant reversed |
Yes Yes Yes Yes Yes |
No No No No No |
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Medication Review |
Analgesia (i.e. opiates - Fentanyl, morphine, tramadol, methadone, etc.) Benzodiazepines Lasix (Consider K+ replacement, drug interactions) IV medications Antibiotics (Consider for lengthened QTc interval) |
Yes Yes Yes Yes
Yes |
No No No No
No |
Naloxone (Narcan®) - NASAL SPRAY - intramuscular - intravenous - subcutaneous - endotracheal - intranasal - sublingual |
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Lab Review |
K+ (WNL) Hbg (WNL) Urea (WNL) Creatinine (WNL) LKC’s (WNL) PT/PTT/aPPT Blood gas interpretation Other (cultures pending) |
Yes Yes Yes Yes Yes Yes Yes Yes |
No No No No No No No No |
Current value/date |
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Respiratory Rate |
< 20 bpm |
Yes |
No |
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Temperature |
36.1 – 37.2 °C |
Yes |
No |
If febrile, consider sepsis or other |
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Heart Rate |
WNL (<100 bpm) |
Yes |
No |
If tachycardia, correct/consult |
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Blood Pressure |
WNL (Canadian guidelines) |
Yes |
No |
Value/Comment |
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Pain Scale Pain quality/location |
0 1 2 3 4 5 6 7 8 9 10
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Urine Output |
0.5 ml/kg/hr |
Yes |
No |
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ECG |
Normal sinus rhythm Arrhythmias within last 24 hours Ectopic beats QTc interval examined |
Yes Yes Yes Yes |
No No No No |
If yes, consider cardiac consult >500 ms 4-fold increase in sudden death |
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ETCO2 |
<21 |
Yes |
No |
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SPO2 |
>90% on 30% FiO2 |
Yes |
No |
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Fluid balance (consider perfusion notes if applicable) |
Positive (liters) Negative |
Yes Yes |
No No |
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Hemodynamically Stable:
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CVP (2 mmHg – 12 mmHg) PA Pressure (8-13 mmHg) Cardiac Output (4-8 L/min) Intra-arterial pressure (readings are at least 10mmHg higher than cuff BP readings) |
Yes Yes Yes Yes |
No No No No |
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Sputum Production |
Color Amount (sm, med, lg, copious) |
Yes Yes |
No No |
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Chest Tube |
Indications for Removal (NEJM YouTube Video) |
Yes |
No |
CXR 12-24 hours post removal |
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Stage of Weaning |
Stage 1 |
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Yes Yes Yes Yes Yes Yes Yes |
No No No No No No No |
Comments |
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Stage 2 (think about extubation) |
date |
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Stage 3 |
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Stage 4 |
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Stage 5 |
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Stage 6 |
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Stage 7 |
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Weaning Technique |
T-tube trial PS Intermittent Mandatory Ventilation (IMV) Combination of above |
Yes Yes
Yes Yes |
No No
No No |
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Minute Ventilation – normal is about 6L/min = Ve |
<10 L/min |
Yes |
No |
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Rapid Shallow Breathing Index (RSBI) = f/Vt ratio |
<105 |
Yes |
No |
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VC |
10-15 mls/kg IBW |
Yes |
No |
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NIF |
-20 to -30 cmH20 minimum acceptable in adult population |
Yes |
No |
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Respiratory Rate |
20 – 25 bpm |
Yes |
No |
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Other |
Caloric balance restored |
Yes |
No |
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Consults initiated (state) |
See additional sheet |
Yes |
No |
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ICD-10 classification |
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Discharge Teaching |
Drug-drug interactions (www.qtdrugs.org); CPR/First Aid; Signs & Symptoms of Opiate/Methadone overdose fridge magnet; Signs & Symptoms of Anaphylaxis fridge magnet; medical alert tag; Narcan Nasal Spray teaching video; Narcan Nasal Spray device |
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Organ retrieval: criteria met: yes or no Peer Death Review: Yes/No Chart referred to DNP Yes or No
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Date Consult Initiated |
Department |
Physician/NP Allied Healthcare Professional |
Reason for Consult |
Follow-up |
Outcome |
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References
Cavallone, L. F., & Vannucci, A. (2013). Extubation of the Difficult Airway and Extubation Failure. Anesthesia & Analgesia, 116(2), 368-383.
Howie, W. O., & Dutton, R. P. (2012). Implementation of an evidence-based extubation checklist to reduce extubation failure in patient with trauma: A pilot study. AANA Journal, 80(3), 179-184.
Naloxone: Drug information. (1978-2014). Retrieved from http://www.uptodate.com/contents/naloxone-drug-information?source=search_result&search=narcan&selectedTitle=1%7E98
Ontario Hospital Association. (2011). Strategies for reducing preventable mortality.
The Joint Commission. (2012). Safe use of opioids in hospitals. Retrieved from http://www.jointcommission.org/assets/1/18/SEA_49_opioids_8_2_12_final.pdf
Tobin, M. J. (2006). Principles & practice of mechanical ventilation (2nd ed.). New York: McGraw-Hill.
Urden, L. D., Stacy, K. M., & Lough, M. E. (2002). Thelan’s critical care nursing diagnosis and management (4th ed.). St. Louis, Missoursi: Mosby Inc.
Van Noorde, C., Eijgelsheim, M., & Stricker, B. H. (2010). Drug- and non-drug-associated QT interval prolongation. British Journal of Clinical Pharmacology, 70(1), 16-23.
