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By M.D. Peter G. Bourne

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R e c e n t hospitalization, imprison­ m e n t , and v o l u n t a r y abstinence all increase t h e risk of o p i a t e overdose w h e n t h e drug user r e t u r n s t o his h a b i t . IV. Unusual Clinical S i t u a t i o n s T h e following Ust identifies certain peculiarities t h a t m a y arise in t h e t r e a t m e n t of t h e heroin overdose p a t i e n t t h a t d o n o t fit t h e " t y p i c a l " profile described in Section II. 1. AGITATION In the setting of opiate overdose agitation is an i m p o r t a n t sign.

Nightingale I. II. III. IV. Pharmacology and Use of Methadone Elements of the Medical History Physical Examination and Differential Diagnosis Immediate Management A. Respiratory Support B. Gastric Lavage C. Specific Antidote V. General Management A. Close Monitoring B. Narcotic Antagonist C. Oxygen D. Pulmonary Edema E. Aspiration Pneumonitis F. Overdose from a Combination of Drugs: Further History and Laboratory Tests G. Hospitalization VL FollowupCare 41 42 43 4^ 44 4^ 45 46 ^ 47 47 47 48 48 I.

3. PULMONARY EDEMA If p u l m o n a r y e d e m a has developed, t r a c h e o s t o m y with positive pressure respiration m a y be necessary. Such respirators should n o t be used with e x t e r n a l cardiac compression. 4. THE PATIENT MUST NOT BE LEFT UNATTENDED UNTIL FULLY RESPONSIVE T h e increased illicit use of m e t h a d o n e which has a m u c h longer d u r a t i o n t h a n t h e n a r c o t i c antagonists m a y bring a b o u t situations in which t h e p a t i e n t is fully responsive and t h e n lapses back i n t o c o m a (Dole et al, 1 9 7 1 ; Kjeldgaard et al, 1 9 7 1 ) .

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