Letter Dr. Shahab
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The document is an email exchange between Dr. Shahab, the Chief Medical Health Officer of Saskatchewan, and Gary Thompson regarding Saskatchewan's potential development of a Take Home Naloxone program. Dr. Shahab explains that Saskatchewan does not currently have a THN program but if one was developed, the training materials would be based on best evidence for when and how to administer naloxone and appropriate interventions to support breathing and circulation. Thompson expresses concern over a quote indicating training would include chest compressions only for opioid overdoses, and provides links arguing rescue breaths should be administered before and after naloxone.
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![On Tuesday, April 21, 2015 7:46 PM, "Shahab, Saqib HE0"
<Saqib.Shahab@health.gov.sk.ca> wrote:
Dear Mr Thompson
Thank you for your voicemail, e mail and links. At present SK does not
have a THN (Take Home Naloxone) program and if SK was to develop
one, training materials related to that would use the best information
and evidence regarding that including when and how to administer
Naloxone and additional appropriate interventions as required to
support airway, breathing and circulation.
Thank you once again for flagging your concerns
Sincerely
Dr Saqib Shahab FRCPC
Government of Saskatchewan
Chief Medical Health Officer
Ministry of Health, Population Health Branch
3475 Albert St, Regina SK S4S 6X6
E mail: sshahab@health.gov.sk.ca
Tel: 306 787 3220
From: Gary Thompson [mailto:jgary.thompson@mail.utoronto.ca]
Sent: Tuesday, April 21, 2015 2:43 PM
To: Shahab, Saqib HE0 Subject: Re: News article April 18
Dr. Shahab:
Read with grave concern your quote of April 18
"A key feature of the take home program is training users' family or
peers to recognize signs of overdose so they know when and how to
administer the antidote, perform CPR compression's and call 911"
http://www.thestarphoenix.com/health/Opiate+antidote+kits+possible+
Sask/10983748/story.html
I hope this does not mean chest compressions only? Contraindicated
for any respiratory emergency patient.
Still not correct rescue
breaths then Naloxone
continue breaths.](https://image.slidesharecdn.com/0d253ff6-f785-4e53-96e0-b148d4779e3e-150525044348-lva1-app6892/85/Letter-Dr-Shahab-1-320.jpg)
![Read all moderated comments 2015 AHA & ILCOR guidelines [My
moderated comment video format https://youtu.be/PX0HQuaNS_I
'Opioid overdose Response Education' BLS 891 reopened for comment
Feb. 2017]
https://volunteer.heart.org/apps/pico/Pages/PublicComment.aspx?q=89
1
My response to Emily Oliver (awaiting AHA moderator)
Quote Emily "....use of naloxone into their education programs. More
research is needed regarding educational effectiveness..."
Do we need more research on opioid poisoning resuscitation
protocols? Clinicians see opioid poisoning daily in a clinical situation.
Terminally ill are kept "comfortable" to wit OD narcotics. Cause of
death acute respiratory failure.
European Resuscitation Council Guidelines for Resuscitation 2010
Section 8.b Poisoning
http://resuscitation-guidelines.articleinmotion.com/article/S0300-
9572(10)00441-7/aim/
Opioids
Opioid poisoning causes respiratory depression followed by
respiratory insufficiency or respiratory arrest. The respiratory effects
of opioids are reversed rapidly by the opiate antagonist naloxone.
Modifications for Advanced Life Support
There are no studies supporting the use of naloxone once cardiac
arrest associated with opioid toxicity has occurred. Cardiac arrest is
usually secondary to a respiratory arrest and associated with severe
brain hypoxia. Prognosis is poor.
Agnotology is the study of culturally induced ignorance or doubt,
particularly the publication of inaccurate or misleading scientific
[medical] data. Agnotology focuses on the deliberate fomenting of
ignorance or doubt in society.
http://issuu.com/garythompson81/docs/agnotologynote.docx](https://image.slidesharecdn.com/0d253ff6-f785-4e53-96e0-b148d4779e3e-150525044348-lva1-app6892/85/Letter-Dr-Shahab-2-320.jpg)
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CPA Naloxone July 2016Gary Thompson
油
The document discusses the importance of naloxone for opioid overdose treatment, highlighting its role in reversing respiratory depression and preventing brain injury. It outlines the recognition of overdose symptoms, proper administration techniques, and the availability of naloxone across Canadian provinces. Additionally, it provides case studies for pharmacists to consider naloxone distribution and addresses the safety of naloxone for various demographics.Complications Chest Compressions
Complications Chest CompressionsGary Thompson
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You would think it brutal to withhold from the less capable the air they need. The moment you begin discriminating against the less capable, you establish conditions that breed dissatisfaction and resentment: you invite envy, discord and strife. Alexander Berkman Life of an Anarchist p.282 More info Google @GaryCPRRed Cross First Aid
Red Cross First AidGary Thompson
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The document discusses first aid procedures for breathing emergencies. It notes that the Canadian Red Cross' procedures from 1970 are still applicable today and in the future - to provide rescue breaths as soon as possible for any breathing emergency. It also references that St. John Ambulance has current first aid information.Heart and Stroke Foundation letter
Heart and Stroke Foundation letterGary Thompson
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This document provides information from various sources on cardiopulmonary resuscitation (CPR) and opioid overdose treatment. It includes links to training videos on signs of respiratory emergency and proper treatment, which emphasize that rescue breathing is essential for any respiratory emergency. The document also discusses debates around protocols for treatment of opioid overdose and cases where naloxone was ineffective in reversing overdoses in children.Heart and Stroke Foundation letter
Heart and Stroke Foundation letterGary Thompson
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The document discusses public health training regarding oxygen deprivation and the importance of rescue breathing as part of basic first aid. It references various online training resources and videos, along with a historical protocol from 1996. The author expresses concern about confusion stemming from a new protocol introduced in February 2016.CBC Cross Country Check-up Jan 31 2016
CBC Cross Country Check-up Jan 31 2016Gary Thompson
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This document discusses respiratory emergencies caused by opioid overdoses and the appropriate treatment, which is rescue breathing not chest compressions. It references several studies and experts who state that chest compressions are the wrong treatment for respiratory emergencies and could cause harm, as the issue is a lack of oxygen not a cardiac problem. It provides links to information from organizations, guidelines, and experts that all recommend rescue breathing instead of chest compressions alone for opioid overdoses.Case reports children; women
Case reports children; womenGary Thompson
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This case report describes a 2-year-old girl who presented to the emergency department with lethargy and possible seizure activity after opioid overdose. Initial CT scan showed symmetric low attenuation in the white matter and cerebellar hemispheres with effacement of the prepontine cistern, suggestive of opioid overdose. She was intubated for airway protection and respiratory support. Naloxone was administered but was ineffective. She was diagnosed with opioid-induced acute cerebellitis requiring ventriculostomy and suboccipital decompressive craniectomy for hydrocephalus and cerebellar edema. This case highlights the neurosurgeon's role in diagnosing and treating opioid overdose-inducedCase reports children women etc
Case reports children women etcGary Thompson
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A 2-year-old girl presented to the emergency department with lethargy and possible seizure activity after opioid overdose. CT scan showed symmetric low attenuation in the white matter and cerebellum with minimal effacement of cisterns. Naloxone was ineffective and urine toxicology was positive for opioids. Pulmonary edema can occur hours after revival with naloxone due to inadequate respiratory assistance and is a major risk for any respiratory emergency patient. Neurosurgical intervention may be required for opioid-induced acute cerebellitis presenting with hydrocephalus and cerebellar edema.Case reports children and women
Case reports children and womenGary Thompson
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This case report describes an opioid overdose in a 2-year-old girl who presented to the emergency department with lethargy and possible seizure activity. Initial CT scan revealed symmetric low attenuation in the white matter of the cerebrum and cerebellar hemispheres and effacement of the prepontine cistern, suggestive of opioid overdose prior to toxicology confirmation of opiates in her urine. She was resuscitated, intubated, and administered naloxone without effect. In cases of opioid-induced acute cerebellitis, neurosurgical intervention such as ventriculostomy or suboccipital decompressive craniectomy may be required for acute hydrocephalus and cerebellCase reports women and children
Case reports women and childrenGary Thompson
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This case report describes an opioid overdose in a 2-year-old girl who presented to the emergency department with lethargy and possible seizure activity. Initial CT scan revealed symmetric low attenuation in the white matter and cerebellar hemispheres with effacement of the prepontine cistern, suggestive of opioid overdose prior to toxicology confirmation of opiates on urine screening. She was intubated for airway protection and administered naloxone without effect. In cases of opioid-induced acute cerebellitis, neurosurgical intervention such as ventriculostomy or suboccipital decompressive craniectomy may be required for acute hydrocephalus or cerebellar edema with herniationLetter Dr. Aaron Orkin
Letter Dr. Aaron OrkinGary Thompson
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Dr. Aaron Orkin expressed his desire not to communicate further during a phone conversation with Gary Thompson regarding the naloxone protocol in the CPR guidelines. Thompson claimed he had no issues with the University of Toronto, contrary to Orkin's suggestion. Dr. Orkin mentioned receiving numerous calls for an article on opioid overdose and emphasized the issue affects individuals who have never used drugs.Ad
Letter Dr. Shahab
- 1. On Tuesday, April 21, 2015 7:46 PM, "Shahab, Saqib HE0" <Saqib.Shahab@health.gov.sk.ca> wrote: Dear Mr Thompson Thank you for your voicemail, e mail and links. At present SK does not have a THN (Take Home Naloxone) program and if SK was to develop one, training materials related to that would use the best information and evidence regarding that including when and how to administer Naloxone and additional appropriate interventions as required to support airway, breathing and circulation. Thank you once again for flagging your concerns Sincerely Dr Saqib Shahab FRCPC Government of Saskatchewan Chief Medical Health Officer Ministry of Health, Population Health Branch 3475 Albert St, Regina SK S4S 6X6 E mail: sshahab@health.gov.sk.ca Tel: 306 787 3220 From: Gary Thompson [mailto:jgary.thompson@mail.utoronto.ca] Sent: Tuesday, April 21, 2015 2:43 PM To: Shahab, Saqib HE0 Subject: Re: News article April 18 Dr. Shahab: Read with grave concern your quote of April 18 "A key feature of the take home program is training users' family or peers to recognize signs of overdose so they know when and how to administer the antidote, perform CPR compression's and call 911" http://www.thestarphoenix.com/health/Opiate+antidote+kits+possible+ Sask/10983748/story.html I hope this does not mean chest compressions only? Contraindicated for any respiratory emergency patient. Still not correct rescue breaths then Naloxone continue breaths.
- 2. Read all moderated comments 2015 AHA & ILCOR guidelines [My moderated comment video format https://youtu.be/PX0HQuaNS_I 'Opioid overdose Response Education' BLS 891 reopened for comment Feb. 2017] https://volunteer.heart.org/apps/pico/Pages/PublicComment.aspx?q=89 1 My response to Emily Oliver (awaiting AHA moderator) Quote Emily "....use of naloxone into their education programs. More research is needed regarding educational effectiveness..." Do we need more research on opioid poisoning resuscitation protocols? Clinicians see opioid poisoning daily in a clinical situation. Terminally ill are kept "comfortable" to wit OD narcotics. Cause of death acute respiratory failure. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8.b Poisoning http://resuscitation-guidelines.articleinmotion.com/article/S0300- 9572(10)00441-7/aim/ Opioids Opioid poisoning causes respiratory depression followed by respiratory insufficiency or respiratory arrest. The respiratory effects of opioids are reversed rapidly by the opiate antagonist naloxone. Modifications for Advanced Life Support There are no studies supporting the use of naloxone once cardiac arrest associated with opioid toxicity has occurred. Cardiac arrest is usually secondary to a respiratory arrest and associated with severe brain hypoxia. Prognosis is poor. Agnotology is the study of culturally induced ignorance or doubt, particularly the publication of inaccurate or misleading scientific [medical] data. Agnotology focuses on the deliberate fomenting of ignorance or doubt in society. http://issuu.com/garythompson81/docs/agnotologynote.docx
- 3. Not placing blame, change this protocol of Public Health Ontario. Have talked with all these clinicians many times in person, they live in a state of pure guilt.