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Non-pharmaceutical fentanyl (NPF) is a major contributor to opioid overdoses and overdose fatality. In certain urban areas such as Vancouver, over 80% of heroin samples contain NPF. For isolated heroin overdose ED patients, they can be safely discharged after brief observation period (~2 hours). However, “safe” observation time for fentanyl is unknown.
Recently, a retrospective study evaluating the safe observation period in 1009 suspected (uncomplicated) fentanyl overdose ED visits (827 unique patients).
Results:
In the field:
- 476 (47.1%) received bystander naloxone
- 422 (44.1%) had field GCS of 15
- 547 (57.2%) had pulse oximetry of >= 95%.
- EMS administered naloxone to 546 (57.1%) patients (mean dose 0.4 mg IV)
In the ED:
- 16 patients received additional naloxone in the ED
- Mean length of stay: 173 minutes (IQR: 101 to 267 minutes)
- 90% of the patients were discharged within 380 minute.
- One patient was admitted and one patient died after discharge within 24 hours.
Conclusion:
- Majority of the patients were safely discharged after 3 - 4 hours after receiving naloxone and if able to maintain GCS 15 with oxygen level 95% while able to ambulate normally.
- However, some patient may require up to 6 hours of observation.
References
Scheuermeyer FX et al. Safety of a brief emergency department observation protocol for patients with presumed fentanyl overdose. Ann Emerg Med 2018 (PMID: 29530654)