Medical Personnel: Drug Overdose Questions

Well, how an OD manifests depends on many things: how much he takes, how he takes it, how tolerant he is to the drug, what his general health is like, what else he might have taken etc. A sufficiently large cocaine overdose can be fatal within a couple of minutes. Signs and symptoms can be pretty diffuse, though.

What's fairly common in the beginning stages is fast breathing, rapid pulse (but sometimes the pulse is slow instead), agitation and emotional instability often with aggressive/violent behavior, tremors, headaches, chest pain and nausea. That progresses to seizures, loss of muscle control (including bladder), irregular/interrupted respiration, cardiac arrhythmia, and finally on to coma and cardiac/respiratory arrest. It's not a pretty death.

If you want the guy to die, have him die before EMS gets there. Most ODs that get medical help in time survive. That applies to heroin, too, but if you do manage to kill yourself like that around here, it's generally at least partly due to heroin/other opioids (or you take some MDMA variation and die of dehydration.) I don't see fatal cocaine overdoses all that often. But for extra death, you can always combine cocaine and heroin and make a speedball.

What the dispatcher should tell the other guy depends in what the patient is doing at the time. If he's still breathing he should be put in the recovery position, which is a stabilized way to lay someone on their side in such a way that their airway is kept open. If he's not breathing, then yes, CPR.
Here's where many bystanders balk. These patients often have various bodily fluids on them by now, they might have been convulsing and the bystanders don't really want to touch such a patient. So it's quite possible to OD surrounded by your "friends" and nobody does anything. Then there are the people that base their "first aid" on something they vaguely remember reading or watching somewhere, like this one guy who tried to help his girlfriend by ramming a syringe into her chest based on what he'd seen in Pulp Fiction. He didn't have epinephrine available (fortunately), so he used a mixture of water and vodka. (Luckily he hit the sternum and the needle broke off. She wasn't as bad as he thought and ended up being fine. Don't know if they're still together.)

You will have to decide on his drug of choice, because OD'ing on junk is different from OD'ing on Meth; although cardiac arrest is often the cause of death in both. Junkies fairly often drown on their vomit. And sometimes a junkie's heart can be restarted with an injection of saline directly to the heart.

Hi TT42

You say you want to know ALL the variables. Well, good luck there, as has been alluded previously.

That being said, here are a few thoughts you may find useful:

1. Does the person really want to die?

There is a difference between a "cry for help" and someone who is determined to die. We see and treat many in the former category (some of them die, too). The coroner sees more from the latter category.

So, you say the person really wants to die. That means that they will not be committing this act in a way that would have them found until they are dead. You will need to take this into account if they are discovered nonetheless.

2. Overdose can mean many things. Dying from a overdose from most street drugs is rather uncommon if the person is found early.

They can do things to make death more likely.

Take an overdose while sitting on a high-up balcony perhaps. The fall will kill them when they tumble down.

You ask for unusual one: A wife of an anaesthetist wishes to kill herself. She manages to get her hands on a vial of Ketamine, gives herself a big intramuscular injection, and jumps in the swimming pool. (Real case)

3. Take a drug that kills rapidly. This means a lethal dose of cyanide, that sort of thing. A large dose of IV potassium. It burns like fire if a large dose and concentration goes in rapidly. Not something a druggie is likely to manage.

4. Multiple drugs. Here, there are many variables. We can usually figure out after a few hours what drugs have been ingested, but if they are not detected, and get into the system, you may die anyway.

The point here is, you die later. Often much later. If EMS gets to you, you may get charcoal, which will limit absorption of many drugs. In the ER you may get gastric lavage, particularly if you are unconscious, and have taken "extended release" medication.

Some of the most toxic drugs out there are drugs that work on the cardiac system. Beta-blockers and calcium channel blockers are bad in overdose. Despite our best efforts, we do on occasion get into a situation where nothing will save them. But understand that this is often much later, after decontamination, many drugs, cardiac pacing, and dialysis.

I hope this is useful, select and discard.

But the bottom line is: Folks are unlikely to die from regular street drugs if found soon after ingestion. Something else will need to happen as well. If it must be drug-related - a poly substance ingestion with cardiac drugs in the mix might do it. But later.

Have, er, fun!
CB

King Neptune said:

And sometimes a junkie's heart can be restarted with an injection of saline directly to the heart.

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Where did you hear that?

To the OP, - two things to keep in mind. Different drugs work on different receptors in the body. If your character overdoses on cocaine (stimulant), you can't reverse the reaction with heroin (downer), etc. You need to google if there is a competing drug, and find out what "it" or "they" are, for the drug that you chose. Drug of choice to compete against morphine (which is metabolized from heroin), is naloxone.

Also, if an ambulance shows up to help a drug overdose, keep in mind that ambulances are equipped for emergencies. Many of the drugs aboard have a higher dosage or a higher concentration over what you'd find issued for a patient that is recovering in a hospital.

I admire your wanting to research and find out all the facts. Just be careful not to get too caught up in the science of all this, most readers will get bored with the facts. Keep your scene as a story, don't let it become a science project.

asroc said:

Where did you hear that?

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That's what junkies do.

Reminder: treat any medical advice recited on the internet with skepticism unless confirmed by a medical practitioner that you know and trust.

King Neptune said:

That's what junkies do.

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Do you have a source for that?

Cath said:

Do you have a source for that?

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Quentin Tarantino, in his video of the technique demonstrated by Dr. Johnny Revolting in Pulp Fiction!

KN may be referring to Epinephrine (Adrenaline) solution in saline being injected into the heart. That went the way of the dodo bird a long time ago.

CB

Cath said:

Do you have a source for that?

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I do not give the names or other identifying information of criminals. They generally like to avoid having such information made public. If you want more about then I suggest that you search on google. Using "heroin overdose saline solution" I got this http://forum.opiophile.org/archive/index.php/t-2791.html and many other results, and some of those results say that it is ineffective.

Well, several posters in your own source correctly point out this is bullshit. I can imagine that there are people who try this, but it doesn't work and it's a terrible idea.
Drug addicts are not a reliable source for medical treatment. I treat drug overdoses for a living. Saline injection does not restart a stopped heart, ever.
If you find someone who has overdosed or is otherwise unconscious a) call 911, b) if they are breathing, put them into the recovery position and make sure they keep breathing, c) if they are not breathing, clear their airway and start CPR. No slapping, no stun gun, no "antidotes," no injection with anything, especially not into the heart. At best you'd only be wasting time with that, but those are great ways to kill people, too.

I agree with everything Asroc said, except if they're not breathing, check for a pulse first. If there isn't one, then start CPR. If they have a pulse, do rescue breaths. No sense breaking anyone's ribs for fun if you can avoid it.

Just in case anyone is interested in where this idea comes from (this being a research thread for writing, not a scientific debate, after all):

Intracardiac injection of epinephrine became popular about a century ago.

Here is the link to the first page of the article. The date is 1923.

Over time, the practice fell into disuse. Nevertheless, it was still being used on occasion. Here are the ACLS guidelines from 2000, where the cautious use of intracardiac epinephrine is mentioned as a last resort.

The use of intracardiac epinephrine was initiated by cardiac surgeons during thoracotomy, in other words, when the chest was open, the pericardium (sac around the heart) was open, and the injection could be done under direct vision, thus limiting damage to structures.

More recently, the idea of doing thoracotomies in the ER, for resuscitation has had a bit of a resurgence. Here is an article from 2013 describing the use of epinephrine for direct injection into the heart.

There are other reasons for putting a needle into the chest. One of them, is to attempt to drain fluid that has collected in the pericardium, the sac that surrounds the heart, in an attempt to relieve pressure on the heart.

Often, we will put saline into the syringe, so that it is easier to identify air coming back through the needle, meaning we are in the lung, not the pericardial sac, or heart.

This is all rather desperate stuff, and certainly not the kind of thing to do in the field, Vincent Vega notwithstanding.

So, there are some things to play with here, if you wish to write fiction that skirts the borders of realism.

However, injecting saline into the heart to resuscitate a heroin overdose will likely not work to satisfy most critics.

Now, have an off-duty ER doc who just happens to have a vial of epi in his bag, with a syringe and suitably long needle, gonads of titanium, and really good malpractice insurance - well, go for it!

In the real world, not so likely. But this is FICTION, not FRICTION. It''s OK to be a little wild in our imaginings.

CB

thethinker42 said:

I suspect you've never received a lengthy e-mail from a reader detailing your every factual failure in a book. Or even more fun: a review doing the same.

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No, I haven't. For that I would need to be published. Something I am working on.

Of course, it would mean someone read my book!!!

My point was that there was a wisp of truth to the rumour, that could be used, if carefully dissected. Your mileage, as the saying goes, may vary.

And... a book REVIEW. Wow. We've obviously experienced different thrills in life, so far. Your writing thrills make me envious. Don't envy my medical thrills, sometimes the reviews can be a bit too detailed, and harsh too.

Best
CB

CoolBlue said:

In the real world, not so likely. But this is FICTION, not FRICTION. It''s OK to be a little wild in our imaginings

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Yes of course it is, but if you want any old unsubstantiated information, use Google. The point of this forum is to get expert advice and real world experience, so it is absolutely fair to ask for sources here.

Cath said:

Yes of course it is, but if you want any old unsubstantiated information, use Google. The point of this forum is to get expert advice and real world experience, so it is absolutely fair to ask for sources here.

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Oh, I was not suggesting that asking for sources was not useful, Cath. Not at all.

I was trying to add a bit of detail to the misguided idea that injecting saline in the field would be a useful idea. I was concerned that the baby might be found in the frozen bathwater that was tossed out the window, so to speak.

And, I did add references.

No offence intended. If any was construed, my apology. (Why is this emoticon thing not working? Runs off to change the batteries)

Best
CB

BrightSera said:

I agree with everything Asroc said, except if they're not breathing, check for a pulse first. If there isn't one, then start CPR. If they have a pulse, do rescue breaths. No sense breaking anyone's ribs for fun if you can avoid it.

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Modern guidelines no longer trust laypeople to check for a pulse first. Ditto rescue breathing. I can't say I'm happy with hands-only CPR, but considering the average civilian's skill level there's certainly a reason it exists.

asroc said:

Modern guidelines no longer trust laypeople to check for a pulse first. Ditto rescue breathing. I can't say I'm happy with hands-only CPR, but considering the average civilian's skill level there's certainly a reason it exists.

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Yeah, pulse check AFTER the saline to the heart.

CB