The Modern-Day Plague

​Part 1 in a Four-part SeriesA 32-year-old man was taken to the ED by EMS after being found unresponsive in a subway station. His pupils were pinpoint, and he was breathing at fourth breaths per minute. He had a blood pressure of 94/63 mm Hg, pulse oximetry of 91% on room air, and a heart rate of 51 beats per minute. He was given 2 mg of intranasal Narcan by EMS and became more responsive, breathing at 14 breaths per minute with a blood pressure of 125/82 mm Hg, heart rate of 74 bpm, and 98% on room air. He admitted in the ED to using three bags of heroin.​The opioid epidemic is a national public health crisis in the United States with more than 90 deaths a day due to drug overdose. (http://bit.ly/2zcfM1s.) That is more than the number of deaths per day from motor vehicle crashes. Nearly half of those overdose deaths are due to opioids. More than 64,000 people died in 2016 from overdose, a nearly 20 percent rise from 2015 and nearly quadruple the number of overdose deaths in 2000. (New York Times. June 5, 2017; http://nyti.ms/2whjiJw.)There are three main opioid receptors: the mu (mu1 and mu2), kappa, and delta. (National Institute on Drug Abuse. June 30, 2017; http://bit.ly/2zcApdS.) Respiratory depression is mu2-mediated. Euphoria is mediated by the mu-delta receptor agonism and subsequent dopamine release in the mesolimbic system. Kappa agonism can also produce analgesia, but it can also cause dysphoria.​The opioid toxidrome consists of miosis, bradyc...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs