Opioid Overdose Happens Outside of Dental Office
Dental staff performed CPR and utilized an AED. Emergency medical services administered NARCAN® Nasal Spray (naloxone HCl) upon arrival.
“Help!” said a man running into a South Carolina dental practice. “I can’t wake up my girlfriend!” Three staff members rushed to a truck in the parking lot and found the victim, whose face was blue and appeared to be passed out. The boyfriend stated he thought she might be having an overdose.
After calling 911, the dental staff and boyfriend removed the woman from the truck and placed her on the ground. They gave CPR and then utilized an automated external defibrillator (AED) from a nearby physician office. EMTs quickly consulted with the dental staff and then administered NARCAN®.
This emergency response revived the woman, who was transported to a local hospital. The dental office has since purchased NARCAN for their emergency medical kit, and an AED.
Dr. Malamed’s Notes
When summoned by a man rushing in from the parking lot, the dental office staff was confronted with an unconscious female who—according to her male friend—was “asleep” and he couldn’t wake her up.
The basics of CPR (basic life support) are the essential steps in managing this situation:
P (Positioning). The unconscious victim was properly removed from the car and placed in a supine position on the ground.
C, A, and B (Circulation, Airway, Breathing). All were evaluated and each step performed as needed.
In this scenario the victim was apneic and had no palpable pulse. She was in cardiac arrest. Cardiopulmonary resuscitation was initiated, and once an AED became available the victim was successfully defibrillated.
On arrival of the paramedics, once it became evident that the victim had overdosed on opioids (from questioning of the boyfriend or the victim herself) naloxone (Narcan)—an opioid antagonist—was administered (either intravenously or intranasally). Then the victim was transported to the hospital’s emergency department for follow-up care.
BE PREPARED FOR ALL POSSIBLE MEDICAL EMERGENCIES
This scenario illustrates the importance of being prepared for all possible contingencies.
Cardiac arrest is an extremely rare emergency event in the dental office environment. However, should cardiac arrest occur, you must immediately begin the steps of basic life support (CPR). Positioning, circulation, airway, and breathing are of critical importance in giving the victim a chance of survival. This is known as “bystander-initiated CPR”.
Equally important is the time that elapses between the collapse of the victim and defibrillation. In the absence of bystander-initiated CPR the victim’s chance of survival (to hospital discharge) decreases between 7% and 10% per minute. With bystander-initiated CPR survival decreases by approximately 3% to 4% per minute. The average national (USA) response time from receipt of the 9-1-1 call to arrival on of the ambulance at the scene of the emergency is approximately 10 minutes.
Another consideration is that irreversible brain damage occurs when neurons are deprived of oxygen for as little as 4 to 6 minutes.
Once this emergency was successfully resolved, the dental office immediately and correctly purchased two important items of emergency equipment: an automated electronic defibrillator (AED) and naloxone (Narcan), either injectable or nasal spray.
How to Respond to an Opioid Overdose