OUT-OF-HOSPITAL TREATMENT OF OPIOID OVERDOSES IN AN URBAN SETTING

Objectives: To investigate clinical outcomes in a cohort of opioid ove rdose patients treated in an out-of-hospital urban setting noted fur a high prevalence of IV opioid use. Methods: A retrospective review was performed of presumed opioid overdoses that were managed in 1993 by t he emergency medical services (EMS) system in a single-tiered, urban a dvanced life support (ALS) EMS system, Specifically, all patients admi nistered naloxone by the county paramedics were reviewed. Those patien ts with at least 3 of 5 objective criteria of an opioid overdose [resp iratory rate <6/min, pinpoint pupils, evidence of IV drug use, Glasgow Coma Scale (GCS) score <12, or cyanosis] were included. A response to naloxone was defined as improvement to a GCS greater than or equal to 14 and a respiratory rate greater than or equal to 10/min within 5 mi nutes of naloxone administration. ED dispositions of opioid-overdose p atients brought to the county hospital were reviewed. All medical exam iner's cases deemed to be opioid-overdose-related deaths by postmortem toxicologic levels also were reviewed. Results: There were 726 patien ts identified with presumed opioid overdoses. Most patients (609/726, 85.4%) had an initial pulse and blood pressure (BP), Most (94%) of thi s group responded to naloxone and all were transported. Of the remaind er, 101 (14%) had obvious signs of death and 16 (2.2%) were in cardiop ulmonary arrest without obvious signs of death. Of the patients in ful l arrest, 2 had return of spontaneous circulation but neither survived , Of the 609 patients who had initial BPs, 487 (80%) received naloxone IM (plus bag-valve-mask ventilation) and 122 (20%) received the drug IV. Responses to naloxone were similar; 94% IM vs 90% IV. Of 443 patie nts transported to the county hospital, 12 (2.7%) were admitted. The a dmitted patients had noncardiogenic pulmonary edema (n = 4), pneumonia (n = 2), other infections (n = 2), persistent respiratory depression (n = 2), and persistent alteration in menial status (n = 2). The patie nts with pulmonary edema were clinically obvious upon ED arrival. Hypo tension was never noted and bradycardia was seen in only 2% of our pre sumed-opioid-overdose population. Conclusions: The majority of the opi oid-overdose patients who had initial BPs responded readily to naloxon e, with few patients requiring admission, Noncardiogenic pulmonary ede ma was uncommon and when present, hypoxia was evident upon arrival to the ED, Naloxone administered IM in conjunction with bag-valve-mask ve ntilation was effective in this patient population. The opioid-overdos e patients in cardiopulmonary arrest did not survive.