Dual Diagnosis

Biography

Biography: Gary Thompson

Abstract

I read with grave concern the article by Leece, et al. about Toronto's opioid overdose prevention program and teaching laypersons the signs of respiratory emergency and training them to give chest compressions only. Omitted from the training literature were the signs of opioid overdose. Those include not being able to wake up the person; slow, erratic, or stopped breathing; deep snoring or gurgling sounds; blue or purple fingernails or lips; limp body; and very small pupils. These signs would indicate a poisoned patient in coma suffering a respiratory emergency. Cardiac arrest is secondary to respiratory arrest and is associated with severe hypoxia. Prognosis is poor. The patient now needs ACLS beyond the scope of laypersons. The authors note that “significant numbers of opioid-related deaths involve polysubstance overdose with cardiotoxic drugs.” The author's 29th reference makes slim mention of cardiotoxic drugs. Stimulants and other toxins may cause a dysrhythmia, and drugs of abuse cause death from acute respiratory failure. Cyanosis can be cardiotoxic, myocardial infarction can be from lack of oxygen in bloodstream, and every tissue and all organs are dying from lack of oxygen. The authors write, “Painful stimulation may be an effective means of increasing respiratory drive.” This needs redress (primum non nocere); the complications of chest compressions are endless. BLS adds oxygen to the bloodstream. I could find no consensus for chest compressions only for respiratory emergencies, including opioid poisoning (overdose).