You are working in your community clinic and are running late. You go to the waiting room to call the next patient, with no response. You ask reception who said they went to the bathroom a few minutes ago. You check back in a few minutes, and your patient is still not back. Growing slightly concerned, you go knock on the locked bathroom door. There is no response.
What do you do?
As there is no response, it is appropriate for you to attempt opening the door.
Describe how you would do this in your setting.
You and a colleague open the door to find your patient slumped over, blue. There is a needle on the ground.
How do you respond?
This is a medical emergency, and you should immediately call for help, either by calling out or activating code blue over the phone system.
Make the scene safe by donning PPE and removing the needle.
As the first one to be on scene, you are the default team leader. Delegate staff to:
- safely transfer the patient to the ground, maintaining C-spine precautions if you are concerned
- call 911
- obtain the medical emergency kit
- record events as they occur
- print the chart summary
- manage the scene in regards to other patients/visitors
Discuss where emergency kit components are in your clinic.
How do you assess the patient?
Maintain focus on the ABCs, assessing and treating as needed:
- Airway: do a chin tilt or jaw thrust
- Breathing: assess rate of breathing, providing ventilation with BVM and oxygen if needed
- Circulation: assess pulse, beginning compressions if not found
The patient is not breathing, but does have a strong pulse of 60.
What do you assess next?
The situation strongly suggests drug overdose, given the presentation and the needle found. You assess the pupils and find them to be pinpoint, further supporting your diagnosis.
You also consider hypoglycemia, doing a glucometer check. It is normal.
What further treatment do you provide?
Intramuscular naloxone is the standard treatment for suspected overdose, and you ask a team member to prepare this, according to clinical experience or protocol.
Thankfully the patient rapidly begins to respond, and sits up with you.
The EMS team arrives. How do you hand over?
Using SBAR format, clearly and concisely describe:
- identification
- situation as was found
- brief patient background
- assessment (presumed opioid overdose)
- recommendation (transport to hospital for further monitoring)
After EMS departs, the team chats for a few moments about the drug problem in your community.
What are the major causes of drug overdose in your area?
Discuss this, with a particular focus on the new fentanyl derivatives that are available across North America.
