BOH July 13 2017

My deputation Toronto Board of Health item HU 12.1 July 13, 2017 on their data base

Cities info “3. Directed the Medical Officer of Health to present to the Board of Health Budget Committee with an initial proposed budget that enhances the quality health services provided by Toronto Public Health.”

Everyone would agree a happy work place is a productive and cost effective workplace.  Some common quotes from Doctors and Registered Nurses employed by Toronto Public Health while crying “Gary I know the ‘POINT’ protocol is killing anyone with any breathing emergency, I just work for the psychopaths”

I know and have talked with many employees at different Community Health Centres in Toronto common quotes “We have major problems in many areas with head office staff”

Addendum something any layperson should understand not in the original deputation Hug Carl C. Jr. MD, PhD, Anesthesiology ‘Opioids: clinical use as anesthetic agents’ Journal Pain Symptom Management 1992 Aug;7(6):350-5
Quote “Although there is a very wide margin of safety, allowing administration of enormous doses intraoperatively when the patient’s ventilation is supported mechanically, the disadvantage of using doses far in excess of the individual patient’s need is a prolonged recovery from anesthesia with the risk of postoperative ventilatory depression”
Response: Surgery patient are OD’d kept alive ventilation’s, awakened by stopping drug flow and kept oxygenated [rescue breathing and antidote layperson [Anesthesiologist rarely use antidote]]. Doctor’s not supposed to assault and murder us with chest compression’s as many in Ontario suffering any breathing emergency have. Signs of OD can mimic any of the hundreds of causes breathing emergency.

Paul Newman stars in ‘The Verdict’ 1982 “The case involves a young woman who was given an anesthetic during childbirth, after which she choked on her own vomit and was deprived of oxygen. The young woman is now comatose and on a respirator.”

BACK TO THE DEPUTATION

Chair Joe Mihevc June 12, 2017 BOH quote “Dr. Eric Hoskins just gave $450,000 for staff hires and 80,000 Naloxone kits”  Some people in the gallery started clapping, a little prematurely is my thought.

Board of Health video June 12, 2017 ‘Clapping to your doom’   https://youtu.be/7zNDy9x0PgA

Photo from the June 12, 2017 press conference Note “chest compression’s only”  Leave any respiratory emergency patient un-oxygenated hypoxia is occurring which costs not only the taxpayer needlessly but also the patient.  Let us not forget the sign’s of drug OD can mimic any breathing emergency rescue breaths essential ASAP.

Dangerous Plus

Left to right Councilor Joe Cressy (Chair Toronto Drug Strategy); Joe Mihevc (Chair BOH): Mayor John Tory; Eric Hoskins MD Ontario’s Minister of Health.

234 Doctors, other health care professionals and myself signed a letter to Ontario’s Premier Kathleen Wynne and Minister of Health Dr. Eric Hoskins about Ontario’s life threatening intervention.  Read meaningless response from Premier.  https://www.linkedin.com/pulse/letter-kathleen-wynne-dr-eric-hoskins-gary-thompson

Deputation Brooklyn McNeil March 21, 2016 HL 10.1 Repeated posthumously July 4, 2016 at 1 hour 4 minutes  Quote Brooklyn “Dropped off at ‘The Works’ started CPR and Naloxone”  Question was chest compression’s applied? I have a strong suspicion her heart was beating and required breaths and Naloxone only.  http://app.toronto.ca/tmmis/video.do?id=10902

July 11, 2016 by Megan Marrelli ‘Remembering Brooklyn McNeil, Toronto’s Advocate for Safe Injection Sites’ http://torontoist.com/2016/07/remembering-brooklyn-mcneil-torontos-advocate-for-safe-injection-sites/

Jan 9, 2017 Toronto’s Mayor John Tory and Barbara Yaffe MD quoted “Ventilation’s (rescue breathing) most important” Chest compression’s only still being taught!! Read comment box YouTube Medical info hyperlinked https://youtu.be/kv7QhyhDsHw

Quotes Mayor above press conference at 37 minutes https://youtu.be/Ww-_Vg3GC1Q

“When you have a CRISIS…one thing that often stands in the way…different protocols people have…that they have protocols that are well agreed upon…this person didn’t tell me that…we have a different system here…this is what causes people to lose their lives quite literally.” http://www.citynews.ca/2017/01/09/officials-meet-in-toronto-to-tackle-fentanyl-issues/

My letter ‘Flaws in Toronto’s Opioid Overdose Prevention Program’ EMN 2015; 37(12):31 With hyperlinks to Public Health Ontario’s training literature, and also the proper protocol.  http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx

References

BREATHS stabilize patient essential first per all medicine anything less is gross negligence for any breathing emergency Dr. Nicholas Etches  http://www.cbc.ca/player/play/895066691568/

DHSP Cambridge MA ‘When Overdose Happens: What to do’

Nathan Harig of Cumberland Goodwill EMS, Carlisle, PA ‘Naloxone Hydrochloride’ 

Following just one of many Ontario’s training resources. See my letter EMN above for more links.   Ontario video quote “stop breathing” that’s the cause of death alright.  Another Public Health quote “give chest compression’s only” that’s just going to make sure you stay dead.

Case reports Naloxone ineffective keep alive rescue breaths till EMS arrives essential  https://aliascpr.wordpress.com/2017/06/08/sociopath-doctors/

50,000 Ontarians are poisoned each year 28,000 children  http://www.sickkids.ca/AboutSickKids/Newsroom/Past-News/2007/50000-Ontarians-are-poisoned-each-year-according-to-the-Ontario-Poison-Centre.html

15,000 out of hospital cardiac arrests per year Ontario https://www.ices.on.ca/Newsroom/News-Releases/2014/Survival-rates-improving-for-out-of-hospital-cardiac-arrest-patients

Read the 7 moderated comments Tim Noonan 30 years EMS blog http://roguemedic.com/2015/02/proposed-2015-acls-chest-compression-only-cpr-vs-conventional-cpr-recommendation/

Annotated medical info ‘Naloxone’ and my moderated comments 14-15 Then follow trackback for more of my moderated comments http://roguemedic.com/?s=Naloxone

Medscape ‘Naloxone for the Reversal of Opioid Adverse Effects’  Quote “All patients considered to have opioid intoxication should have a stable airway and adequate ventilation established before the administration of naloxone.”  http://www.medscape.com/viewarticle/441915_4

cf my response https://jgarythompson.wordpress.com/2016/11/02/medscape-naloxone/

Lange ‘Poisoning and drug OD’ see page 1 ad fin item https://murdercube.com/files/Chemistry/Poisoning%20and%20Drug%20Overdose%20(4th%20Edition).pdf

Lange newer edition http://accessmedicine.mhmedical.com/content.aspx?bookid=391&sectionid=42069814

2010 American Heart Association Guidelines Part 12.7: Toxic Ingestions  http://circ.ahajournals.org/content/122/18_suppl_3/S829.full#sec-80

Quote AHA  “ventilation should be assisted by a bag mask [rescue breaths layperson italics mine] followed by administration of naloxone and placement of an advanced airway [continue breaths layperson italics mine] if there is no response to naloxone .

Toxidromes   “Practically every sign and symptom observed in drug overdose can be produced by natural disease, and many clinical presentations associated with natural disease can be mimicked by some poison.“

Response: Any of the hundreds of causes respiratory emergency mimic an overdose, rescue breaths ASAP.

My moderated comments 2015 AHA & ILCOR guidelines ‘Opioid Overdose Response Education’ with hyperlinks Ontario Public Health life threatening protocols in comment box  https://youtu.be/PX0HQuaNS_I

All 70+++ references from 2015 AHA & ILCOR guidelines on opioid overdose quotes ‘rescue breathing  then naloxone continue breaths’  https://aliascpr.wordpress.com/2015/12/13/2015-ilcor-and-aha-references-opioid-od/

INCHEM.org ‘Naloxone’ Quote “it is extremely important to give oxygen and to support ventilation immediately while waiting for naloxone to be available for injection.”    http://www.inchem.org/documents/antidote/antidote/ant01.htm#SubSectionNumber:2.12.3

2015 European Resuscitation Council Guidelines for Resuscitation  Section 4. ‘Toxins’ p.165  Quotes “fewer adverse events when airway opening, oxygen administration and ventilation are carried out before giving naloxone”  “Large opioid overdoses may require a total dose of up to 10 mg of naloxone”  “In respiratory arrest there is good evidence for the use of naloxone, but not for any other adjuncts or changes in interventions.”   https://cprguidelines.eu/sites/573c777f5e61585a053d7ba5/content_entry573c77e35e61585a053d7baf/573c78115e61585a053d7bce/files/S0300-9572_15_00329-9_main.pdf

Goldfrank’s ‘Toxicologic Emergencies’ page 566  http://freepages.school-alumni.rootsweb.ancestry.com/~dpok/Goldfrank%E2%80%99s%20Toxicologic%20Emergencies%209th%20Edition.pdf

Quotes “The consequential effects of acute opioid poisoning are CNS and respiratory depression.  Although early support of ventilation and oxygenation is generally sufficient to prevent death, prolonged use of bag-valve-mask ventilation and endotracheal intubation may be avoided by cautious administration of an opioid antagonist.”  “Differentiating acute opioid poisoning from other etiologies with similar clinical presentations may be challenging.” [previous means doctors have trouble diagnosing one respiratory emergency from another]

Dr. Gordon Ewy the world expert chest compression’s only, phoned me “Gary don’t stop what you are doing” Twenty years of his research thrown down the drain by Public Health Ontario.
Quote “Some doctors worry that bystanders can get confused and do only chest compression’s in drug-overdose and drowning cases [any asphixia or poisoning italics mine] NOT TO BE GIVEN TO CHILDREN.”

Email from Dr. Ewy Oct 15, 2015 release date resuscitation guidelines Quote “This is unbelievable”

Sociopath Doctors

Scroll read case reports women and children Naloxone ineffective

Letter Rita 2012

 

2010 AHA & ERC guidelines sent to Dr. Shahin found hyperlinked in comment box

Quote AHA “”ventilation should be assisted by a bag mask [rescue breaths layperson italics mine] followed by administration of naloxone and placement of an advanced airway [continue breaths layperson italics mine] if there is no response to naloxone.”

Quote ERC “In severe respiratory depression caused by opioids, there are fewer adverse events when airway opening, oxygen administration and ventilation are carried out before giving naloxone.”

Modifications for Advanced Life Support
“There are no studies supporting the use of naloxone once cardiac arrest associated with opioid toxicity has occurred. Cardiac arrest is usually secondary to a respiratory arrest and associated with severe brain hypoxia. Prognosis is poor.”

Jan 9, 2017 Toronto’s Mayor John Tory and Barbara Yaffe MD quote “Ventilation’s (rescue breathing) most important” Chest compression’s only still being taught!! Read comment box YouTube https://youtu.be/CycS5GeylbM

Quotes Mayor above press conference at 37 minutes “When you have a CRISIS…one thing that often stands in the way…different protocols people have…that they have protocols that are well agreed upon…this person didn’t tell me that…we have a different system here…this is what causes people to lose their lives quite literally.”

My letter ‘Flaws in Toronto’s Opioid Overdose Prevention Program’ EMN 2015; 37(12):31 With hyperlinks to Public Health Ontario’s training literature, and also the proper protocol.

RN Toronto Public Health incident BMJ ‘Doc2Doc’ “Every worked with a psychopath”

Darryl Gebien MD ‘The Air I Breathe’ written, sung and recorded dedicated to his Mother who passed Fentanyl OD

letterMOHdec132013 001

LETTERMORRISON 002

2010 AHA Co-Chair Dr. Laurie Morrison Guidelines Part 12.7:
2010 ILCOR Co-chair Dr. Laurie Morrison Guidelines Part V section B ‘Poisoning Drug OD’
UNDOC/WHO 2013 Opioid overdose Page 7 layman’s language
2010 Compressions only CPR AHA Guidelines Part 4
Canadian Red Cross

Signs of overdose same as many breathing emergencies
1. Can’t wake the person up (COMA)
2. Slow erratic or stopped breathing
3. Deep snoring or gurgling sounds (CHEYNE-STOKES)
4. Blue or purple fingernails or lips (CYANOSIS)
5. Limp body
6. Very small pupils (MIOSIS)
Signs prove the heart is beating rescue breaths ASAP life depends on breaths.

Andrew Reisner, MD et al. ‘Opioid overdose in a child: case report and discussion with emphasis on neurosurgical implications” J Neurosurg Pediatr 2015 16(6); 752–757
Quote first paragraph page 753 “Naloxone was administered without effect”

Case report babies1

Case report babies2

Case Report women

POSTER STILL UP JUNE 2017 MANY DOCTOR”S OFFICES AND COMMUNITY HEALTH CENTRES IN ONTARIO ONLY PLACE IN THE WORLD THAT TEACHES THIS

TPHinsideOFFICEFixed

QWCHC Jan 13A

Ontario Pharmacists Association ‘How to kill your own Grandma & Mother her own child’

Case report Jake at 7 minutes. 4 breaths/min BVM = (rescue breathing ESSENTIAL) then Naloxone. Continue rescue breaths mandatory until next slide 14 breaths/min oxygen level 97%

DR1

DRA

AS DONE THE WHOLE WORLD OVER ANY BREATHING EMERGENCY RESCUE BREATHING ONLY

Canadian PA

Letters from video

Video Watch this crazy training

Simple analogy The human body is like a car, engine (heart) will not run if air intake manifold (lungs) not working properly. Pushing on the motor (heart) will not fix lungs (manifold) in fact you will break the engine block (rib cage) ad fin item. Oil (blood) becomes fouled (lack of air) which damages all internal engine parts (humans cells, tissues and organs). Supply air (rescue breaths) by opening carburetor (wind pipe) by tilting head back, pinch nose) breathe air into lungs (manifold) which keeps the heart (motor) running and un-fouls the blood (oil). ‘ How Stuff Works ‘Manifold‘

HYPERLINKS TO MEDICAL TEXTBOOKS ETC. SCROLL BOTTOM it’s not rocket science

Training literature in Ontario, Canada can’t read the instructions but got funding to teach assault and murder
‘NALOXONE: Saves lives, learn how, share the knowledge’
Quote ‘Coma and stop breathing’ Better be giving breaths ASAP then Naloxone continue breaths as per all medicine

‘Naloxone training at Toronto Public Health’ Getting anyone with any breathing emergency assaulted and murdered at 9:20 minutes and 21:30 minutes

‘The POINT’ see slide 23

GradeTWOB

Leece P; Orkin A.et al ‘Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.’ CJPH 2013; 104(3)e200-4
My response above article

Leece P; Orkin A. quote “Opioid users deserve the same high-quality, evidence-based practice as other patients.” JAMA 2013;309(9)873 in response to Beletsky et al ‘Prevention of Fatal Opioid Overdose’  JAMA 2012; 308(18):1863-4

Quote Beletsky “During the time it typically takes some overdoses to turn fatal, it is possible to reverse the respiratory depression and other effects of opioids with the antagonist naloxone”

CJPH1

CJPH2

CJPH3

CJPH4

Heart & Stroke Foundation Official site read the only  my moderated comment AliasCPR

Letter H&S Foundation 001

Correspondence from Public Health etc found hyperlinked this Deputation Board of Health  letterSHOPKINSsept2013 001

LETTERMORRISON 002

Laurie Morrison MD 2010 AHA Guidelines Part 12.7

Laurie Morrison MD 2010 ILCOR 8.5 Drug Overdose and Poisoning
UNDOC/WHO 2013 Opioid overdose Page 7 layman’s language

Compressions only CPR AHA Guidelines 2010 Part 4
Canadian PA

Why did they not read the label monograph Naloxone?

CPSnaloxone1

CPS OD 2015A

TPHinsideOFFICEFixed

SIGNS of CARDIAC & RESPIRATORY ARREST

American Heart Association Guidelines Part 12.7: Toxic Ingestions
Toxidromes
“Practically every sign and symptom observed in drug overdose can be produced by natural disease, and many clinical presentations associated with natural disease can be mimicked by some poison.“
Response: Any of the hundreds of causes respiratory emergency mimic an overdose, rescue breaths ASAP. 2015 AHA guidelines refer you to the 2010 guidelines, suggest everyone follow what 2010 says.

2015  AHA guidelines  Guidelines are published every five years in October.

One of my comments in the 2015 AHA & ILCOR guidelines

2015AHA Part10p1

Quote next article bottom left corner “Survival from cardiac arrest is not from Naloxone but from vigorous support of respiration’s” Patient [in cardiac arrest] is most likely brain dead lack of oxygen, that’s why give breaths early keeps the heart beating for any of the hundreds of causes breathing emergency.

Roberts, James R. ‘Intranasal Naloxone for Prehospital Opioid Overdose’ EMN 2014; 36(7)4-6  Following from this article

EMN 2013; 36(7)4-6

Tweet from Ontario Paramedics May 1, 2017  Hope your Grandma does not take an extra couple pain pills, or your young child to get into the medicine cabinet.

Ontario Paramedics

Naloxone Rx

Letters from Public Health etc hyperlinked in comment box

Feb 27, 2017 training literature

50,000 Ontarian’s are poisoned each year 28,000 children http://www.sickkids.ca/AboutSickKids/Newsroom/Past-News/2007/50000-Ontarians-are-poisoned-each-year-according-to-the-Ontario-Poison-Centre.html
May I suggest you teach people to save their lives instead of killing them all with chest compression’s.

Ontario Pharmacist Association ‘How to kill your own Grandma & Mother her own child’ https://youtu.be/1a_SRu82jlw
https://youtu.be/aZ2SPcHUsvA Case report Jake @7:25 minutes. 4 breaths/min BVM = (rescue breathing ESSENTIAL) then Naloxone. Continue rescue breaths mandatory until next slide 14 breaths/min oximetry 97%

Lange [A gold standard of medical textbooks] ‘Poisoning and drug OD’ see page 1 ad fin item https://murdercube.com/files/Chemistry/Poisoning%20and%20Drug%20Overdose%20(4th%20Edition).pdf
Current edition http://accessmedicine.mhmedical.com/content.aspx?bookid=391&sectionid=42069814

American Heart Association Guidelines Part 12.7: Toxic Ingestions http://circ.ahajournals.org/content/122/18_suppl_3/S829.full#sec-80
Toxidromes
“Practically every sign and symptom observed in drug overdose can be produced by natural disease, and many clinical presentations associated with natural disease can be mimicked by some poison.“
Response: Any of the hundreds of causes respiratory emergency mimic an overdose, rescue breaths ASAP. 2015 AHA guidelines refer you to the 2010 guidelines, suggest everyone follow what 2010 says.

My moderated comments 2015 AHA & ILCOR guidelines ‘Opioid Overdose Response Education’ with hyperlinks Ontario Public Health life threatening protocols in comment box

Use your brain Drugs nor poisons did not magically change their chemical structure, nor did human evolve and breathing is no longer necessary.
Opioids http://www.inchem.org/documents/antidote/antidote/ant01.htm#SubSectionNumber:2.12.3

2015 European Resuscitation Council Guidelines for Resuscitation
Section 4. Cardiac arrest in special circumstances ‘Toxins’ p.165
https://cprguidelines.eu/sites/573c777f5e61585a053d7ba5/content_entry573c77e35e61585a053d7baf/573c78115e61585a053d7bce/files/S0300-9572_15_00329-9_main.pdf?
Quotes “fewer adverse events when airway opening, oxygen administration and ventilation are carried out before giving naloxone” “Large opioid overdoses may require a total dose of up to 10 mg of naloxone” “In respiratory arrest there is good evidence for the use of naloxone, but not for any other adjuncts or changes in interventions.”

Goldfrank’s Toxicologic Emergencies p.566 etc.
http://freepages.school-alumni.rootsweb.ancestry.com/~dpok/Goldfrank%E2%80%99s%20Toxicologic%20Emergencies%209th%20Edition.pdf
Quotes “The consequential effects of acute opioid poisoning are CNS and respiratory depression. Although early support of ventilation and oxygenation is generally sufficient to prevent death, prolonged use of bag-valve-mask ventilation and endotracheal intubation may be avoided by cautious administration of an opioid antagonist.” “Differentiating acute opioid poisoning from other etiologies with similar clinical presentations may be challenging.” [previous means doctors have trouble diagnosising one respiratory emergency from another]

Roberts, James R. ‘InFocus: Dissecting the ACLS Guidelines on Cardiac Arrest from Toxic Ingestions’ EMN 2011; 33(10)16-18
http://journals.lww.com/em-news/Fulltext/2011/10000/InFocus__Dissecting_the_ACLS_Guidelines_on_Cardiac.7.aspx

DEAD WRONG Margaret Thompson MD Director Ontario Poison Centre ‘Street Opioid Resuscitation Recommendations’ For the General Public
http://www.ontariopoisoncentre.ca/pdf/72758-GenPubguidelines_naloxone_v2.pdf Accessed March 12, 2017

CORRECT Ontario Poison Centre Step 2 BVM = rescue breathing continue breaths all times. Start low dose naloxone’Street Opioid Resuscitation Recommendations’ For Pre-Hospital and Hospital Care
http://www.ontariopoisoncentre.ca/pdf/72759-Hopsitalguidelines_naloxone_v2.pdf Accessed March 12, 2017

Pulse oximeter https://youtu.be/AJeJjTjwLbQ

Dr. Nicholas Etches Medical Officer of Health http://www.cbc.ca/player/play/895066691568/

All 70+++ references from 2015 AHA & ILCOR guidelines on opioid overdose quotes ‘rescue breathing only’
https://aliascpr.wordpress.com/2015/12/13/2015-ilcor-and-aha-references-opioid-od/

Dec. 22, 2015 Public Health Ontario Grand rounds: GREY MEDICAL LITERATURE!! My comment at 7:30 minutes Note attendee Dr. Barbara Yaffe second in command Toronto Public Health
https://pho.adobeconnect.com/_a1158264515/p7bfeq33hj7?launcher=false&fcsContent=true&pbMode=normal

Read the monographs that come with Naloxone Don’t do as Ontario, Canada teaches chest compressions that’s assault and murder.
https://jgarythompson.wordpress.com/2016/06/29/monographs-naloxone-opioid-od/

College Physicians Surgeons Ontario does not bring a doctor in on a whim
https://jgarythompson.wordpress.com/2016/09/17/cpso-complaints/

‘Medscape’ Physicians most trusted site, my moderated comment https://jgarythompson.wordpress.com/2016/11/02/medscape-naloxone/

https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-6-26 Quote “most participants did not carry the naloxone with them consistently and consequently it was generally not available if they witnessed an overdose.”
Other studies report same >20% of the time Naloxone left elsewhere. Probably means chest compression’s only used in Ontario?

Complications chest compression’s a drastic measure only to be preformed cardiac arrest.
Atcheson SG, Fred HL. ‘Letter: Complications of cardiac resuscitation’ Am Heart J. 1975 Feb;89 (2):263-5 http://www.slideshare.net/GaryThompson11/complications-chest-compressions-64269212

Toronto Public Health taught ‘Direction 180’ this protocol Halifax CBC May 19, 2016 http://www.cbc.ca/news/canada/nova-scotia/naloxone-lifesaving-halifax-pilot-project-1.3588567
Signs prove heart is beating needs breaths ASAP Quote “The man’s lips were blue, his breathing was slow and he was in a confused state, the telltale symptoms of an opiate overdose. “I’m slapping the guy, I’m shaking him, right,” said Marshall. Marshall said he rolled his friend over, filled the syringe with naloxone, jabbed the needle into his friend’s backside and then started chest compression’s. Soon, his friend started to snap awake. During training, he learned that drug users often react violently when they emerge from an overdose.

Owner (a pharmacist) Shoppers Drug Mart  location I took the OD training Dec. 31 called “His store will no longer give out Public Healths OD protocol chest compression’s.” He has escalated the complaint about this murderous teaching.
https://aliascpr.wordpress.com/2017/01/01/pharmacy-od-training-dec-2016/

Women and children Naloxone ineffective kept alive rescue breathing kept them alive http://www.slideshare.net/GaryThompson11/case-reports-children-women-57633650

Marcia L. Buck ‘Naloxone for the Reversal of Opioid Adverse Effects’ Pediatric Pharmacotherapy. 2002;8(8)1-5
See bottom page 1 children kept alive five days respiratory assist. Doctors pumping massive doses Naloxone into children with no affect? Both toddlers probably would have woken up and started breathing on their own in the same time period without all the Naloxone.
https://med.virginia.edu/pediatrics/wp-content/uploads/sites/237/2015/12/200208.pdf

Annotated medical info ‘Naloxone’ and my moderated comments 13-14 Then follow comment 15 for more of my moderated comments http://roguemedic.com/?s=Naloxone

April 26, 2016 234 Doctors, other health care professionals and myself signed a letter to Ontario’s Premier Kathleen Wynne and Minister of Health Dr. Eric Hoskins about Ontario’s life threatening intervention.
See meaningless response from Premier https://www.linkedin.com/pulse/letter-kathleen-wynne-dr-eric-hoskins-gary-thompson

Scripture quotes rescue breathing https://aliascpr.wordpress.com/2016/10/23/scripture-rescue-breaths/

My letter ‘Flaws in Toronto’s Opioid Overdose Prevention Program’ EMN 2015; 37(12):31 With hyperlinks to Public Health Ontario’s training literature, and also the proper protocol.
http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx

Heart & Stroke Foundation Official site read the only moderated my comment AliasCPR https://youtu.be/Wy3eEES511E
Letter from H & S Foundation http://www.slideshare.net/GaryThompson11/heart-and-stroke-foundation-letter

Dr. Ewy (The world expert chest compression’s only) phoned me “Gary don’t stop what you are doing”
Quote “Some doctors worry that bystanders can get confused and do only chest compressions in drug-overdose and drowning cases [any asphixia or poisoning etc] NOT TO BE GIVEN TO CHILDREN.”
http://www.azcentral.com/news/articles/2010/01/19/20100119cardiacdoc0119.html Email from Dr. Ewy https://aliascpr.wordpress.com/2016/06/25/email-dr-gordon-awy/

Sent the following video etc to Dr. Ewy and contact info of Michael Parkinson of Waterloo Region Crime Prevention Council Original ‘Eyes Wide Open’ https://www.youtube.com/watch?v=znjKdfYRCGc
“My childhood friend was completely blue…. Started with chest compressions didn’t seem to have any real great effect”
Correct Joe you are quickening Wades death or anyone else with a breathing emergency. Sadly Wade pasted summer 2015

Dan Bigg on OD it’s not rocket science https://www.youtube.com/watch?v=7MYKYScL8L8 Rescue breathing first line defense Naloxone is second line defense
Original video @8 minutes https://www.youtube.com/watch?v=RcPB2Ybpyd8

Your pet eats a poison or drug Veterinarian will give respiratory assist and any antidote, not torture them with chest compression’s only. Why would we allow this to our women and children?

It’s a mental illness called Anosognosia a severe form of denial. Anosognosia is quite different than simple or temporary denial. It is not simply denial of a problem, but the genuine inability to recognize that the problem exists. Usually this is caused by brain damage and/or FEAR!

Agnotology is the study of culturally induced ignorance or doubt, particularly the publication of inaccurate or misleading scientific [medical] data. Agnotology focuses on the deliberate fomenting of ignorance or doubt in society.

Not placing blame, change this protocol for the well being of all. Stop needless suffering Google @GaryCPR for more info

Responding to OD 04/21/2017

Seventy people attended the public forum.  Manager ‘The Works’ Shaun Hopkins a no show.

How painful was this presentation two EMS were present??

Ten’s of thousands in Ontario, Canada taught all the signs of breathing emergency (Drug OD), then trained to give chest compression’s. Empower laypersons what they think is a life saving technique they are eager to follow a clinicians instructions assaulting and murdering any breathing emergency patient. Increases mental and physical illness drug use and abuse, dysfunctional society.

‘Survival rates improving for out-of-hospital cardiac arrest patients’ http://www.ices.on.ca/Newsroom/News-Releases/2014/Survival-rates-improving-for-out-of-hospital-cardiac-arrest-patients
40,000 out of hospital cardiac arrest events each year Canada equals 15,000 in Ontario the only time you give CPR.  A lot less sudden witnessed cardiac arrests the only time chest compression’s only (read letter Heart & Stroke Foundation). Over a million people presented to Ontario hospitals per year with respiratory emergency. Chest compression’s for respiratory emergency is assault and murder, their heart is beating.  Rescue breaths ASAP your life depends on breaths.

Heart & Stroke Foundation Official site read my moderated comment AliasCPR https://youtu.be/Wy3eEES511E
Letter from H & S Foundation http://www.slideshare.net/GaryThompson11/heart-and-stroke-foundation-letter

April 21

Pamela Leece MD background April 21 Power Point follows

Leece P; Orkin A.et al ‘Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.’ CJPH 2013; 104(3)e200-4
My response above article https://jgarythompson.wordpress.com/2016/07/04/response-cjph-20131043e200-4/

Leece P; Orkin A. quote “Opioid users deserve the same high-quality, evidence-based practice as other patients.” JAMA 2013;309(9)873 http://jamanetwork.com/journals/jama/article-abstract/1660372

American Heart Association Guidelines Part 12.7: Toxic Ingestions http://circ.ahajournals.org/content/122/18_suppl_3/S829.full#sec-80
Toxidromes
“Practically every sign and symptom observed in drug overdose can be produced by natural disease, and many clinical presentations associated with natural disease can be mimicked by some poison.“
Response: Any of the hundreds of causes respiratory emergency mimic an overdose, rescue breaths ASAP. 2015 AHA guidelines refer you to the 2010 guidelines, suggest everyone follow what 2010 says.

Jan 9, 2017 Toronto’s Mayor John Tory Barbara Yaffe MD MOH Quoted drug OD issue “Ventilations (rescue breathing) most important”
Chest compressions still being taught!! Read comment box YouTube https://youtu.be/CycS5GeylbM

Quotes Mayor above press conference at 37 minutes “When you have a CRISIS…one thing that often stands in the way…different protocols people have…that they have protocols that are well agreed upon…this person didn’t tell me that…we have a different system here…this is what causes people to lose their lives quite literally.”
http://www.citynews.ca/2017/01/09/officials-meet-in-toronto-to-tackle-fentanyl-issues/

50,000 Ontarians are poisoned each year 28,000 children http://www.sickkids.ca/AboutSickKids/Newsroom/Past-News/2007/50000-Ontarians-are-poisoned-each-year-according-to-the-Ontario-Poison-Centre.html
May I suggest you teach people to save their lives instead of killing them all with chest compressions.

Lange [A gold standard of medical textbooks] ‘Poisoning and drug OD’ see page 1 ad fin item https://murdercube.com/files/Chemistry/Poisoning%20and%20Drug%20Overdose%20(4th%20Edition).pdf

Current edition Lange http://accessmedicine.mhmedical.com/content.aspx?

Ontario Poison Centre Step 2 BVM (Bag Valve Mask) = rescue breathing continue breaths all times. Start low dose naloxone  Better find the patient pre cardiac arrest ‘Street Opioid Resuscitation Recommendations’ For Pre-Hospital and Hospital Care
http://www.ontariopoisoncentre.ca/pdf/72759-Hopsitalguidelines_naloxone_v2.pdf Accessed March 12, 2017

Annotated medical info ‘Naloxone’ and my moderated comments #13-14 http://roguemedic.com/?s=Naloxone

‘Medscape’ Physicians most trusted site, my moderated comment https://jgarythompson.wordpress.com/2016/11/02/medscape-naloxone/

Naloxone ineffective Marcia L. Buck “Naloxone for the Reversal of Opioid Adverse Effects” Pediatric Pharmacotherapy. 2002;8(8)1-5 See bottom page 1 children kept alive five days respiratory assist. Doctors pumping massive doses Naloxone into children with no affect? Both toddlers probably would have woken up and started breathing on their own in the same time period without all the Naloxone.
https://med.virginia.edu/pediatrics/wp-content/uploads/sites/237/2015/12/200208.pdf

Thousands more case reports like this in the medical literature Naloxone ineffective. Women and children Naloxone ineffective kept alive rescue breathing. http://www.slideshare.net/GaryThompson11/case-reports-children-women-57633650

Ontario Pharmacist Association ‘How to kill your own Grandma & Mother her own child’ https://youtu.be/1a_SRu82jlw
https://youtu.be/aZ2SPcHUsvA Case report Jake @7:25 minutes. 4 breaths/min BVM = (rescue breathing ESSENTIAL) then Naloxone. Continue rescue breaths mandatory until next slide 14 breaths/min oximetry 97%

Complications chest compression’s a drastic measure only to be preformed cardiac arrest.
Atcheson SG, Fred HL. ‘Letter: Complications of cardiac resuscitation’ Am Heart J. 1975 Feb;89 (2):263-5 http://www.slideshare.net/GaryThompson11/complications-chest-compressions-64269212

James Roberts MD Cardiac arrest from respiratory emergencies a totally different animal than cardiac arrest from heart disease, chance of survival with an intact brain poor.
http://journals.lww.com/em-news/Fulltext/2011/10000/InFocus__Dissecting_the_ACLS_Guidelines_on_Cardiac.7.aspx

Dr. Ewy (The world expert chest compression’s only) phoned me “Gary don’t stop what you are doing”
Quote “Some doctors worry that bystanders can get confused and do only chest compressions in drug-overdose and drowning cases [any asphixia or poisoning etc] NOT TO BE GIVEN TO CHILDREN.”
http://www.azcentral.com/news/articles/2010/01/19/20100119cardiacdoc0119.html Email from Dr. Ewy https://aliascpr.wordpress.com/2016/06/25/email-dr-gordon-awy/

April 26, 2016 234 Doctors, other health care professionals and myself signed a letter to Ontario’s Premier Kathleen Wynne and Minister of Health Dr. Eric Hoskins about Ontario’s life threatening intervention.
See meaningless response from Premier https://www.linkedin.com/pulse/letter-kathleen-wynne-dr-eric-hoskins-gary-thompson

Scripture quotes rescue breathing https://aliascpr.wordpress.com/2016/10/23/scripture-rescue-breaths/

My letter ‘Flaws in Toronto’s Opioid Overdose Prevention Program’ EMN 2015; 37(12):31 With hyperlinks to Public Health Ontario’s training literature, and also the proper protocol.
http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx

aprilLeeceA

Note 6th slide Fentanyl Product  Monograph cf page 25 ‘Overdoseage’ quote “If the clinical situation warrants, establish and maintain a patent airway, administer oxygen and assist or control respiration as indicated, and use an oropharyngeal airway or endotracheal tube if necessary.”

Response: All those technical words mean rescue breathing for layperson essential, use a breathing barrier device. https://www.janssen.com/canada/sites/www_janssen_com_canada/files/product/pdf/durm08052014cpm2_nc.pdf

aprilLeeceB

aprilLeeceC

aprilLeeceD

aprilLeeceE

aprilLeeceF

aprilLeeceG

My letter ‘Flaws in Toronto’s Opioid Overdose Prevention Program’ EMN 2015; 37(12):31 With hyperlinks to Public Health Ontario’s training literature, and also the proper protocol.
http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx

Leece P; Orkin A.et al ‘Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.’ CJPH 2013; 104(3)e200-4
My response above article https://jgarythompson.wordpress.com/2016/07/04/response-cjph-20131043e200-4/

aprilLeeceH

Samira Walji RN Power Point April 21

aprilTPH1

AprilTPH2

aprilTPH3

Dr. Nicholas Etches Medical Officer of Health for Calgary district http://www.cbc.ca/player/play/895066691568/

EMS video https://www.youtube.com/watch?v=35lBf5s-iro

Darryl Gebien MD written, sung and recorded by Darryl ‘The Air I Breathe’ https://soundcloud.com/darryl-j-gebien

Lange [The gold standard of medical textbooks] ‘Poisoning and drug OD’ see page 1 ad fin item https://murdercube.com/files/Chemistry/Poisoning%20and%20Drug%20Overdose%20(4th%20Edition).pdf

Current edition http://accessmedicine.mhmedical.com/content.aspx?bookid=391&sectionid=42069814

All 70+++ references from 2015 AHA & ILCOR guidelines on opioid overdose quotes ‘rescue breathing only’
https://aliascpr.wordpress.com/2015/12/13/2015-ilcor-and-aha-references-opioid-od/

Your pet eats a poison or drug Veterinarian will give respiratory assist and any antidote, not torture them with chest compression’s only. Why would we allow this to our women and children?

Arrow with ‘Naloxone’ was an overlay pop-up done part way through the presentation.

aprilTPH4

aprilTPH5

aprilTPH6

aprilTPH7

STOP CONFUSING CPR FOR BASIC LIFE SUPPORT RESCUE BREATHING ONLY FOR ANY OF THE HUNDREDS OF CAUSES BREATHING EMERGENCY IT’S NOT CARDIAC ARREST.

“You would think it brutal to withhold from the less capable [ANYONE] the air they need. The moment you begin discriminating against the less capable, you establish conditions that breed dissatisfaction and resentment: you invite envy, discord and strife.” Alexander Berkman “Life of an Anarchist” p.282

Not placing blame, change this protocol for the well being of all. Stop needless suffering

TPHinsideOFFICEFixed

Naloxone Nasal Spray 4mg

Phoned the FDA’s Pharmacologist quote “I agree Gary we do seem to have some problems” That’s putting it lightly Ontario, Canada out and out kills everyone with any breathing emergency, chest compression’s only taught. Junior grade school science ‘How the heart and lungs work’

Full handout give 30 people Feb 27, 2017 Toronto’s Kensington Market training session, grossly negligent information.  Have talked with QWCHC many times and other Managers etc. have talked with Public Health many times no change See photo below http://narcannasalspray.ca/pdf/NARCAN-Prescribing-Information-ca-en.pdf

CORRECT Ontario Poison Centre 2017 Step 2 BVM (Bag Valve Mask) = rescue breathing continue breaths all times. Start low dose naloxone ‘Street Opioid Resuscitation Recommendations’ For Pre-Hospital and Hospital Care. Better find any respiratory patient before cardiac arrest because brain death is what causes the arrest, lack of oxygen.
http://www.ontariopoisoncentre.ca/pdf/72759-Hopsitalguidelines_naloxone_v2.pdf Accessed March 12, 2017

Massives doses naloxone can be harmful Clinical opioid withdrawl scale. Massive doses Naloxone 4mg may put patient sever withdrawl needlessly
https://www.drugabuse.gov/sites/default/files/files/ClinicalOpiateWithdrawalScale.pdf

Shannon Riley RN lead OD issue forwarded my info all political parties April 13.  Wake up people anyone with any breathing emergency is being assaulted or murdered in Ontario.  Increases drug use and abuse dysfunctional society.

Shannon Riley April 13

Naloxone Spray

This 8 1/2 X 11″ two sided sheet also handed out Feb. 27, 2017 30 kits handed out

TPH Bar Staff

TPH bar staff2

 

TPHinsideOFFICEFixed

 

JIMA

Many health districts in Ontario, Canada have taught layperson’s all the signs of respiratory emergency drug OD, then trained them to give chest compression’s. Empower ten’s of thousands what they think is a life saving technique they are eagerly following a clinicians contraindicated life threatening orders. The protocol increases mental and physical illness drug use and abuse, dysfunctional society. Signs of drug OD can mimic any breathing emergency rescue breaths ASAP your life depends on breaths. Basic grade school science ‘How the heart and lungs work’

Jan 9, 2017 Toronto’s Mayor John Tory (knows his friends and family that never used a drug are being assaulted/murdered and said something) Mayor and Barbara Yaffe MD MOH Quoted drug OD issue “Ventilations (rescue breathing) most important”
Chest compressions still being taught!! Read comment box YouTube https://youtu.be/CycS5GeylbM

Quotes Mayor above press conference at 37 minutes “When you have a CRISIS…one thing that often stands in the way…different protocols people have…that they have protocols that are well agreed upon…this person didn’t tell me that…we have a different system here…this is what causes people to lose their lives quite literally.”
http://www.citynews.ca/2017/01/09/officials-meet-in-toronto-to-tackle-fentanyl-issues/

Correct per all medicine Dr. Nicholas Etches Medical Officer of Health for Calgary district http://www.cbc.ca/player/play/895066691568/

50,000 Ontarians are poisoned each year 28,000 children http://www.sickkids.ca/AboutSickKids/Newsroom/Past-News/2007/50000-Ontarians-are-poisoned-each-year-according-to-the-Ontario-Poison-Centre.html
May I suggest you teach people to save their lives instead of killing them all with chest compressions.

‘How to kill your own Grandma & Mother her own child’ https://youtu.be/1a_SRu82jlw
https://youtu.be/aZ2SPcHUsvA Case report Jake @7:25 minutes. 4 breaths/min BVM = (rescue breathing ESSENTIAL) then Naloxone. Continue rescue breaths mandatory until next slide 14 breaths/min oximetry 97%

Lange [A gold standard of medical textbooks] ‘Poisoning and drug OD’ see page 1 ad fin item https://murdercube.com/files/Chemistry/Poisoning%20and%20Drug%20Overdose%20(4th%20Edition).pdf
Current edition http://accessmedicine.mhmedical.com/content.aspx?bookid=391&sectionid=42069814

April 26, 2016 234 Doctors, other health care professionals and myself signed a letter to Ontario’s Premier Kathleen Wynne and Minister of Health Dr. Eric Hoskins about Ontario’s life threatening intervention.
See meaningless response from Premier https://www.linkedin.com/pulse/letter-kathleen-wynne-dr-eric-hoskins-gary-thompson

My letter ‘Flaws in Toronto’s Opioid Overdose Prevention Program’ EMN 2015; 37(12):31 With hyperlinks to Public Health Ontario’s training literature, and also the proper protocol.
http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx

Your pet eats a poison or drug Veterinarian will give respiratory assist and any antidote, not torture them with chest compression’s only. Why would we allow this to our women and children?

Scripture quotes rescue breathing https://aliascpr.wordpress.com/2016/10/23/scripture-rescue-breaths/

It’s a mental illness called Anosognosia a severe form of denial. Anosognosia is quite different than simple or temporary denial. It is not simply denial of a problem, but the genuine inability to recognize that the problem exists. Usually this is caused by brain damage and/or FEAR!

Agnotology is the study of culturally induced ignorance or doubt, particularly the publication of inaccurate or misleading scientific [medical] data. Agnotology focuses on the deliberate fomenting of ignorance or doubt in society.

Not placing blame, change this protocol for the well being of all. Stop needless suffering

Naloxone protocol April 4, 2017

My local Shoppers Drug Mart gave me the following information today April 4, 2017.  Told the assistant after reading the info “Let me talk to the pharmacist”  “Why are you handing out this info”  “Gary I have read the info you gave me months ago, they make me do it”  “Your a pharmacist and know about poisoning/drug OD it’s mandatory and no one makes you do anything”  Any sane person given this info should phone or write University of Waterloo or Public Health Waterloo and tell them stop and if they don’t go to the police and have them charged with murder.

Phoned U of Waterloo Pharmacy explained the handout and the signs are any breathing emergency patient needs rescue breaths ASAP their life depends on this.  Response “Wow will put you through to Professor the lead on the issue”  Be assured the staff person I talked with knows the info is wrong.  First class pharmacy school any poisoning/drug OD give breaths ASAP, not allowed in any lab not knowing this.  Left my contact info with the professor and told of my concerns”

One of my articles in the medical journals ‘Flaws in Toronto’s Opioid Overdose Prevention Program’ EMN 2015; 37(12):31 With hyperlinks to Public Health Ontario’s training literature, and also the proper protocol.
http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx

Your pet eats a poison or drug Veterinarian will give respiratory assist and any antidote, not torture them with chest compression’s only.  Why would we allow this to our women and children?

Toronto’s Mayor John Tory (knows his friends and family that never used a drug are being assaulted/murdered and said something) Barbara Yaffe MD Medical Officer of Health Quoted drug OD issue “Ventilations (rescue breathing) most important” Not chest compressions as tens of thousands have been taught in Ontario.
Chest compressions still being taught!! https://youtu.be/CycS5GeylbM  Read comment box YouTube

Quotes Mayor above press conference at 37 minutes “When you have a CRISIS…one thing that often stands in the way…different protocols people have…that they have protocols that are well agreed upon…this person didn’t  tell me that…we have a different system here…this is what causes people to lose their lives quite literally.” Drug OD can mimic any breathing emergency rescue breaths ASAP your life depends on this.
http://www.citynews.ca/2017/01/09/officials-meet-in-toronto-to-tackle-fentanyl-issues/

Correct protocol Dr. Nicholas Etches Medical Officer of Health for Calgary district http://www.cbc.ca/player/play/895066691568/

Poisons nor drugs did not magically change it’s chemical structure and started causing death sudden cardiac arrest.  Nor did humans evolve and we started breathing though an exo skeleton like cockroaches. 

Everyone read the fine print hyperlinks with references, it’s not rocket science.

U of Waterloo April 4th

Ref 1) http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/
Read their link ‘Perform Rescue Breathing or Chest Compressions’  http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/perform-rescue-breathing/
Quote ” When someone has extremely shallow and intermittent breathing (around one breath every 5-10 seconds) or has stopped breathing and is unresponsive, rescue breathing should be done as soon as possible because it is the quickest way to get oxygen into someone who has stopped breathing. If you are performing rescue breathing, you are getting much needed air into someone’s body who will die without it. The difference between survival and death in an opioid overdose depends on how quickly enough oxygen gets into the person’s body.”

Ref 2) http://www.ccsa.ca/Resource%20Library/CCSA-CCENDU-Take-Home-Naloxone-Canada-2016-en.pdf
page 10 “one-way breathing mask”  Read all the references this article.

Ref 3) http://www.albertahealthservices.ca/info/page12491.aspx Alberta info next slide
http://www.albertahealthservices.ca/assets/healthinfo/mh/hi-amh-thn-kit-brochure.pdf

Ref 4) https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm
Quote middle first paragraph  “Since 1996, an increasing number of programs provide laypersons with training and kits containing the opioid antagonist naloxone hydrochloride (naloxone) to reverse the potentially fatal respiratory depression caused by heroin and other opioids.” Proportion of use paper not an indication of success.

Ref 3

AlbertaA1

Region of Waterloo Public Health info

Waterloo 2008 p1

WaterlooScan2010-13

 

Aaron Orkin MD Overdose Treatment

I was at this conference common quotes from people with more authority then myself “Orkin is a dangerous sociopath”  Original power point here https://www.dropbox.com/sh/dhnvt2urjf3lc52/AADqExB7H-J2lE591k8RYev6a/Monday%20Feb%2022%20Sessions/Overdose%20Training%20and%20Naloxone%20Distribution.pdf?dl=0

See the only moderated comment on Heart & Stoke Foundation’s Official site. Post by AliasCPR same info as below https://youtu.be/Wy3eEES511E

Slide 1-2

Orkin, Aaron et al ‘Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.’ Can. J. Public Health 2013;104(3):e200-4

Response:  https://jgarythompson.wordpress.com/2016/07/04/response-cjph-20131043e200-4/

Slide 2 Question ‘The First Aid Paradox”

Response: Scripture quotes rescue breaths https://aliascpr.wordpress.com/2016/10/23/scripture-rescue-breaths/

Self evident truth anyone showing the signs of overdose proves heart is beating dying acute respiratory failure.

Slide 2 (fine print) ‘Guidelines Update: the Science of Changing Lives’ http://3mg34c37ntii24dmio2yy6o5.wpengine.netdna-cdn.com/wp-content/uploads/2015/10/2015-Guideline-Special-CircumstancesUpdate-Infographic1.pdf

Quote #5  “Trained providers should administer naloxone to respiratory arrest patients with suspected opioid overdose”

Response: Laypersons must follow standard medical practice to any respiratory emergency patient. Humankind has known since the invent of opium 5,500 years ago, overdose death you stop breathing. Per all medicine supply respiratory assist essential (rescue breathing) to all respiratory emergency patients.

Orkin1

Slide 3-4

Financial
– None.
-Non-financial
– 2015 American Heart Association Resuscitation Guidelines opioid overdose writing group.

Aaron Orkin et al Part 10: Special Circumstances of Resuscitation
2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
http://circ.ahajournals.org/content/132/18_suppl_2/S501

Response:  All 70+++ references from 2015 AHA & ILCOR guidelines on opioid overdose quotes ‘rescue breathing only’
https://aliascpr.wordpress.com/2015/12/13/2015-ilcor-and-aha-references-opioid-od/

Orkin2

Slide 5-6

The Opioid Epidemic

Orkin3

Slide 7-8

Orkin4

Slide 9-10

Slide 9 (see fine print hyperlink) http://www.overdoseday.com/wp-content/uploads/2013/07/Factsheet-Greater-than-the-Road-Toll-KE-FINAL-15-August-2013.pdf

Quote p.1 “Non-fatal overdose, where someone has stopped breathing, can lead to hypoxic brain injury, caused by a lack of oxygen to the brain. These brain injuries can cause coma, seizures and, in worst case scenarios, brain death. The long-term consequences of hypoxia depend on how long the brain is starved of oxygen. In severe cases, brain injuries from overdoses can leave people in a vegetative state.”

Response: “opioid overdose is a respiratory emergency, not a cardiac arrest until brain dead lack of oxygen”

Orkin5

Slide 11-12

Response: That is an x-ray of pulmonary edema, under ventilate any respiratory emergency patient pulmonary edema can kill you days later. Perpetuating the fear of HIV/AIDS. Coughing image patients alveoli sacs ruptured (pumonary edema) now spewing blood and pus??
http://www.radiologyassistant.nl/en/p50d95b0ab4b90/chest-x-ray-lung-disease.html

cf. fine print hyperlink Gomes, Tara et al. “The burden of premature opioid-related mortality.” Addiction 2014;109(9)p.1482-1488.
http://pubmedcentralcanada.ca/pmcc/articles/PMC4171750/pdf/add0109-1482.pdf

Response: No direct mention cause of death

Orkin6

Slide 13-14

Slide 14

Prevent overdose
Recognize overdose
Respond to overdose with:
– BLS [Basic Life Support rescue breathing italics mine]
– Naloxone

Orkin7

 

Slide 15-16

Quote “First aid training for people who are likely to witness overdose”

Response:  First aid training can save the lives of anyone suffering a respiratory emergency.

50,000 Ontarians are poisoned each year 28,000 are children http://www.sickkids.ca/AboutSickKids/Newsroom/Past-News/2007/50000-Ontarians-are-poisoned-each-year-according-to-the-Ontario-Poison-Centre.html

2010 American Heart Association Guidelines Part 12.7: Toxic Ingestions http://circ.ahajournals.org/content/122/18_suppl_3/S829.full#sec-80

Toxidromes “Practically every sign and symptom observed in drug overdose can be produced by natural disease, and many clinical presentations associated with natural disease can be mimicked by some poison.“

Response: Any of the hundreds of causes respiratory emergency can mimic an overdose, rescue breaths ASAP. 2015 AHA guidelines refer you to the 2010 guidelines, suggest everyone follow what 2010 says.

Slide 16

Walley, AY. et al
‘Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis.’
BMJ. 2013;346:f174 http://www.bmj.com/content/346/bmj.f174

Quote p.1 “providing rescue breathing, and delivering naloxone”

Orkin8

Slide 17-18

McAuley, A. et al ‘Exploring the life-saving potential of naloxone: A systematic review and descriptive meta-analysis of take home naloxone (THN) programmes for opioid users.’ December 2015;(26)12, Pages 1183–1188 http://www.ncbi.nlm.nih.gov/pubmed/26508033

Quote p.1184 “because of ethical concerns related to denying control participants access to a life-saving medication” “reverse opioid overdoses when properly trained” p. 1185 “The content of training interventions was similar across each study and largely comprised of training in recognition, prevention and management of overdose, including life support and naloxone administration” p. 1187 “However using naloxone does not always equate to saving a life as some people may survive without it” “Given the variability of these training characteristics between the studies included in this review we elected not to include any analysis which explored how they might mediate success or not. RCT-level research comparing different THN training structures to determine the most effective delivery methods should be prioritised.” “Therefore the PoU (proportion of use) should be taken literally, not implied as a proportion of success”

Slide 18

Angela K. Clarke et. al. ‘A Systematic Review of Community Opioid Overdose Prevention and Naloxone Distribution Programs’ Journal of Addiction Medicine January 2014 8(3):153-63
https://www.researchgate.net/publication/264004247_A_Systematic_Review_of_Community_Opioid_Overdose_Prevention_and_Naloxone_Distribution_Programs

Quote p.153 “Patients that overdose are in a life threatening situation that requires an immediate medical intervention” “…..respond correctly to witnessed opioid overdose?” P.155 “…appropriate responses to overdose events, such as contacting emergency medical personnel, instructions on rescue breathing…”

Orkin9

Slide 19-20

Rebecca E Giglio, Guohua Li and Charles J DiMaggio Effectiveness of bystander naloxone administration and overdose education programs: a meta-analysis
http://link.springer.com/article/10.1186%2Fs40621-015-0041-8#/page-1

Quote p.1 ” Naloxone has been the standard treatment for overdose effects like respiratory depression, sedation, and hypotension in the emergency department setting for the past 3.5 decades…” p. 2 “…overdose response strategies, such as calling 911 or using rescue breathing.”

Slide 20

“If your teenager misused opioids, would you keep Naloxone in the house?”

Response:  Anyone can overdose Grandmother your child anyone!  Pet eats a poison or drug Veterinarian will give rescue breathing then antidote continue rescue breathing. Not torture them with chest compression’s. Why do we allow this to our women and children??

Case reports women and children Naloxone ineffective kept alive rescue breathing.

Buck, M. L. “Naloxone for the Reversal of Opioid Adverse Effects”  Pediatric Pharmacotherapy. 2002;8(8)1-5  https://med.virginia.edu/pediatrics/wp-content/uploads/sites/237/2015/12/200208.pdf

Quote bottom page 1 “The first case involved an accidental ingestion of 100 mg normethadone by a 1 year old. The patient was initially treated with multiple bolus doses of naloxone, but when respiratory depression recurred, an infusion of 0.04 mg/kg/hr was started. The infusion was continued for 2.5 days. The second infant, a 3 day old, received an inadvertent morphine overdose of 5 mg due to a dosing error while hospitalized. This patient was given 4 naloxone boluses, followed by an infusion of 0.16 mg/kg/hr. The infusion was continued for 5 days, during which repeated attempts to wean the infusion resulted in further worsening of respiratory function. In both cases, the patients were discharged without sequelae.”

Response: Ventilations kept these children alive, Naloxone ineffective.

More case reports Naloxone ineffective kept alive ventilations (rescue breaths).

Medscape  ‘Naloxone for the Reversal of Opioid Adverse Effects’ http://www.medscape.com/viewarticle/441915_4 Read my moderated comment This link has timed out video copied here  https://youtu.be/PX0HQuaNS_I

‘How to kill your own Grandma & Mother her own child’ https://youtu.be/1a_SRu82jlw
Part 1 https://youtu.be/aZ2SPcHUsvA  Case report Jake @7:25 minutes. 4 breaths/min BVM = (rescue breathing ESSENTIAL) then Naloxone. Continue rescue breaths mandatory until next slide 14 breaths/min oximetry 97%

 

Slide 19-20
Orkin10

Slide 21-22

Response:  Common sense there is no evidence use Naloxone in cardiac arrest situation, heart not beating therefore no blood flow.  Patient has most likely suffered sever brain death.

Roberts, James R.  ‘InFocus: Dissecting the ACLS Guidelines on Cardiac Arrest from Toxic Ingestions’ EMN 2011; 33(10)16-18
http://journals.lww.com/em-news/Fulltext/2011/10000/InFocus__Dissecting_the_ACLS_Guidelines_on_Cardiac.7.aspx

Quotes “Don’t confuse post- or pre–arrest toxicologic interventions with the actual cardiac arrest event” “This quote from the guidelines says it all: “There are (still) no data to support the use of specific antidotes in the setting of cardiac arrest” from any toxin.” ” Pharmacologic insults are just so massive and normal metabolism and physiology so deranged that no mere mortal can make a meaningful intervention. The seriously poisoned who maintain vital signs in the ED have the best, albeit never guaranteed, chance of rescue from a modicum of antidotes and intensive supportive care.”  “In a patient not in cardiac arrest and following ventilation and airway control, naloxone may be considered. Because it essentially reverses respiratory depression and coma, the ED part of the opioid code is about finished when the endotracheal tube is placed [Rescue breathing stops complications and keeps patient alive italics mine]”

Slide 22

Protocol increases mental and physical illness, drug use and abuse.  Loss of trust in medical profession, harm reduction and addictions councillors, dysfunctional society.

 

Orkin11

Slide 23-24

Slide 24

What the heck “Don’t pay taxes!!”

Orkin12

Slide 25-26

Rebecca E Giglio, Guohua Li and Charles J DiMaggio ‘Effectiveness of bystander naloxone administration and overdose education programs: a meta-analysis’ J. Urban Health 2003; Jun 80(2):291-301
http://link.springer.com/article/10.1186%2Fs40621-015-0041-8#/page-1

Quote p.1 ” Naloxone has been the standard treatment for overdose effects like respiratory depression, sedation, and hypotension in the emergency department setting for the past 3.5 decades…” p. 2 “…overdose response strategies, such as calling 911 or using rescue breathing.”

Orkin13

Slide 27-28

 

Orkin14

Slide 29-30

Orkin15

Slide 31-32

Orkin16

Slide 33-34

Slide 33

‘Health Canada Statement on Change in Federal Prescription Status of Naloxone’ http://news.gc.ca/web/article-en.do?nid=1027679

Quote “training would be required for those potentially administering the drug”

Response: Rescue breathing is essential.

Slide 34

Liberal MP’s bill proposes ‘Good Samaritan’ immunity during overdoses  http://www.cbc.ca/news/politics/mp-drug-overdose-bill-1.3454146

Quote “we need every tool in the toolbox and this is one of those tools that we could use”  “spending much of the rest of your life in a vegetative state” “come up with some new actions, some new activity, some new interventions.”

Response: Appropriate response essential  “rescue breathing essential”  “vegetative state severe brain hypoxia lack of oxygen” “intervention opioid OD has been know for over 5,000 years you stop breathing”

Orkin17

 

Slide 35-36

Slide 36 nice list of breathing emergencies which mimic signs of drug OD

We should prevent
– Drowning
– Anaphylaxis
– Choking
– Snake Bites
– Hypothermia
– Cardiac arrest
Not treat it!

Response: The layperson is eagerly treating all the above with chest compressions.  Question Give chest compression’s only near drowned; Give EpiPen and chest compression’s;  Chest compression’s only choking; Give antivenin and chest compressions; Hypothermia and chest compression’s ad fin item breathing emergencies???

Orkin18

Slide 37-38

Slide 37

breathing emergencies

Slide 38

Protocol is for a sudden witness cardiac arrest only See below letter from Heart & Stroke Foundation

Dr. Ewy (The world expert chest compression’s only) phoned me “Gary don’t stop what you are doing”
Quote “Some doctors worry that bystanders can get confused and do only chest compressions in drug-overdose and drowning cases [any asphixia or poisoning etc] NOT TO BE GIVEN TO CHILDREN.”
http://www.azcentral.com/news/articles/2010/01/19/20100119cardiacdoc0119.html 

Email from Dr. Ewy https://aliascpr.wordpress.com/2016/06/25/email-dr-gordon-awy/ 

Orkin19

Slide 39-40

Orkin20

Letter H&S Foundation 001