Hospitals see rise in damage of opioid crisis
Iwas checking my emails before heading into work for my shift and came across several regarding the opioid crisis that is affecting so many people in Ohio. Receiving emails about this crisis is unfortunately very common, and I find myself scanning through them just to see if there is any new news.
That day, I received an email from the Columbus Health Department warning of a new strain of opioids that had been seen in other parts of the country that was particularly lethal. I made a mental note about the
information in the email and went about my day.
A few days later while working, I overhead the EMS radio ringing off the hook. We were getting four ambulances with overdose victims from the same scene. There were four other doctors working with me during that time, so we readied ourselves for our incoming patients.
My patient was a young woman who had stopped breathing and had a tube placed into her nose by the paramedics who responded to the scene. The paramedics stated that she was blue and not breathing when they got to her.
The paramedics gave her Narcan, which is the drug that reverses opioid overdoses. She started breathing again, but remained sleepy. As she arrived in the emergency department her respiratory rate had again dropped and she was not responsive. The nurse started looking for a vein in her arms to put an IV, but unfortunately could not quickly locate one because the patient had a history of chronic drug abuse and all of her veins were scarred and not usable.
I gave her another dose of Narcan, and she instantly sat up and asked where she was. She admitted that she was addicted to heroin and had used a new batch of heroin from someone she didn’t know.
My partners in the emergency department saw the other three patients who came from the same scene as my patient. Their patients had also accidentally overdosed on heroin and required several doses of Narcan administration. All four patients needed larger and more frequent doses of Narcan than we typically use, and we suspected we were dealing with a more potent batch of heroin as has been discussed in the news.
These four patients were observed in the emergency department for some time and after they had remained awake and conscious for several hours, they could go home. Prior to being discharged, they were counseled on the consequences of their risky behaviors.
Later in my shift I had a patient who came in because he had several abscesses to his right arm where he had injected heroin. He had tried to drain his abscesses himself by poking them with a safety pin. Unfortunately he made things much worse and he finally gave in and came to the emergency department.
His nurse had alerted me to him because his vital signs were abnormal when he checked in. He had a fever and low blood pressure. It was clear he had a severe infection in his arm, but there were other physical exam findings that had me really concerned.
He had a red rash on his chest and legs that consisted of small red dots. He also had numerous red, painful nodules on several of his fingers. These are two findings that can be indicative of a very serious infection. I started looking him over more carefully from head to toe. I also noticed dark lines that looked like splinters on the nail beds of several of his fingers and toes. When I listened to his heart with my stethoscope I heard an abnormal murmur that the patient said he hadn’t had in the past.
Placing an IV in his arm was challenging for the nurse because of his history of drug abuse and the infection in his right arm, essentially making that limb unusable. He was given several antibiotics.
I consulted our cardiologist because my concern was that he had an infection of the valves of his heart from his history of heroin abuse. He would need an echocardiogram, which is an ultrasound test of the heart. His IV drug use had introduced bacteria to his bloodstream, which had infected his heart and now he was having pieces of the infected tissue traveling throughout his body.
He received several bags of intravenous fluids and antibiotics while in the emergency department and had to be in the hospital for several days. He was seen by an infectious-disease doctor who recommended the patient receive intravenous antibiotics for six weeks. He also was seen by a cardiothoracic surgeon who evaluated him for his need to have his heart valve replaced. The surgeon recommended the patient be seen by an addiction medicine specialist while in the hospital to start the process of treating his addiction to heroin because abstinence from drugs would be paramount to his survival.
Treating a patient for an opioid overdose has become common on every shift that I work. We are also seeing the other consequences of IV drug abuse, many of them life threatening, with increasing frequency. From the trenches of the emergency department, I can tell you this is a huge and complex problem that will affect us all. We have to do something — and fast.