• Glucagon treatment for symptomatic beta blocker overdose

      Fell, Matthew (2011-10-07)
      Symptomatic beta blocker overdose is a relatively uncommon, but potentially life-threatening condition (Sheppard, 2006; Health Protection Agency, 2010). Current definitive treatment for these patients involves intravenous glucagon therapy, and as such, glucagon is considered both a first-line treatment and an antidote in cases of symptomatic beta blocker overdose (Joint Formulary Committee, 2011; National Poisons Information Service, 2011a; 2011b). This case report examines an intentional overdose of propranolol, including paramedic prehospital management, and subsequent in-hospital definitive treatment involving intravenous glucagon therapy. Paramedics have experience and knowledge of administering intramuscular glucagon as part of their formulary, and possess the necessary skills for obtaining intravenous access. Therefore, could intravenous glucagon be considered appropriate for administration by paramedics as a prehospital intervention in cases of symptomatic beta blocker overdose? Abstract published wiht permission.
    • Time: take-home naloxone in multicentre emergency settings: protocol for a feasibility study

      Jones, Matthew; Snooks, Helen; Bulger, Jenna; Watkins, Alan; Moore, Chris; Edwards, Adrian; Evans, Birdie A.; Fuller, Gordon; John, Ann; Benger, Jonathan; et al. (2019-01-14)
      Background Opioids such as heroin kill more people worldwide than any other drug. Death rates associated with opioid poisoning in the UK are at record levels. Naloxone is an opioid agonist which can be distributed in take home ‘kits’. This intervention is known as Take Home Naloxone (THN). Methods We propose to carry out a randomised controlled feasibility trial (RCT) of THN distributed in emergency settings clustered by Emergency Department (ED) catchment area, and local ambulance service; with anonymised linked data outcomes. This will include distribution of THN by paramedics and ED staff to patients at risk of opioid overdose. Existing linked data will be used to develop a discriminant function to retrospectively identify people at high risk of overdose death based on observable predictors of overdose to include in outcome follow up. Results We will gather outcomes up to one year including; deaths (and drug related); emergency admissions; intensive care admissions; ED attendances (and overdose related); 999 attendances (and for overdose); THN kits issued; and NHS resource usage. We will agree progression criteria following consultation with research team members related to sign up of sites; successful identification and provision of THN to eligible participants; successful follow up of eligible participants and opioid decedents; adverse event rate; successful data matching and data linkage; and retrieval of outcomes within three months of projected timeline. Conclusions THN programmes are currently run by some drug services in the UK. However, saturation is low. There has been a lack of experimental research in to THN, and so questions remain: Does THN reduce deaths? Are there unforeseen harms associated with THN? Is THN cost effective? This feasibility study will establish whether a fully powered cluster RCT can be used to answer these questions. https://emj.bmj.com/content/36/1/e10.1. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2019-999.24