E-mails Dr. Christian Vaillancourt

Dr.Vaillancourt wrote 2015 ILCOR guidelines drug OD Dr. Morrison wrote 2010 guidelines drug OD correct. Dr. Vaillancourt refers me to Dr. Morrison see last email.  2015 ILCOR Part 3 toxic ingestions   My moderated comments Hyperlinks BLS 891 and ALS 441 etc.  See below communication Dr. Laurie Morrison apparently a friend of Dr. Vaillancourt.

Quote 2010 AHA & ILCOR guidelines poisoning, drug OD “Practically every sign and symptom observed in poisoning can be produced by natural disease, and many clinical presentations associated with natural disease can be mimicked by some poison. It is important to maintain a broad differential diagnosis, particularly when the history of toxic chemical exposure is unclear.” Means any of the hundreds of causes breathing emergency mimics drug OD, supply rescue breaths essential, it’s not a sudden witnessed cardiac arrest.

All the 70+++++ references 2015 ILCOR & AHA guidelines opioid overdose ALL SAY RESCUE BREATHING NO MENTION ANYWHERE CHEST COMPRESSION’S ONLY
https://aliascpr.wordpress.com/2015/12/13/2015-ilcor-and-aha-references-opioid-od/

vaillancourt-nov

Quote Dr. Vaillancourt Jan 8, 2014 “Not sure we have this in Ottawa”

Ottawa Citizen Aug 29, 2014 Ottawa Citizen Aug 29, 2014  Ottawa’s protocol chest compression’s only See bottom this post

Quote “It launched two years ago [Aug. 31, 2012] to coincide with the annual International Overdose Awareness Day”  “death was classified as respiratory failure, and while medically accurate”  A reliable source told me Dr. Vaillancourt was involved in Ottawa’s Naloxone program, why I questioned him in Ottawa.

From Christian Vaillancourt                                    01/16/14 at 11:14 PM

To Gary Thompson

I still do not fully understand your objection to this program.

Not sure we have this in Ottawa, but naloxone programs such as this one have been implemented to save the lives of opioid addicts who overdose.

I believe the naloxone is meant to be administered quickly by a fellow addict or case worker or family member trained to do so.

Many such patients die in alleys with no case at all, and simple CPR will not work in the case of an opioid OD. Perhaps best to contact a cardiac arrest champion from Toronto if you are looking for support with some of your objections…have you tried Dr. Laurie Morisson?

Christian

From Christian Vaillancourt                                                      01/08/14 at 1:56 PM

To Gary Thompson

Most recent resuscitation guidelines (attached) [he sent Part 5 CARDIAC ARREST not Part 12:7 poisoning a respiratory emergency] moved to recommend compression-only CPR for citizen (not for health care professionals) mostly because it was perceived to be one of the major barrior for people to initiate CPR…it is also the most difficult part of the technique to learn.

For witnessed arrests (those having a cardiac arrest with immediate CPR initiation), since victims already have some oxygen in their lungs that can passively be absorbed, another argument is that any time spend doing ventilations is time lost circulating that oxygen with chest compressions.

In the case of overdoses and children cardiac arrests, the etiology is commonly a respiratory arrest.

Although they would be most likely to benefit from ventilations, once again – barrier to CPR initiation (reluctance to do so) favor an approach encouraging chest compressions alone until professional help arrives.

A few very large studies also seem to support this strategy (no difference in survival comparing chest –compression alone to traditional CPR)

Hope this answers some of your questions?

Christian

Christian Vaillancourt MD, MSc, FRCPC, CSPQ  Associate Professor, Department of Emergency Medicine  Senior Scientist, Ottawa Hospital Research Institute  Research Chair in Emergency Cardiac Resuscitation, University of Ottawa  Associate Medical Director, Regional Paramedic Program for Eastern Ontario

From Christian Vaillancourt                                                     01/07/14 at 7:32 AM

To James Thompson

Thank you for this information Mr. Thompson, but it would help me respond if I understood your concern better.

Are you concerned with the naloxone program described, or with the recommendation for compression-only CPR?

Christian

From Gary Thompson  On Jan 7, 2014, at 2:28 AM,<jgary.thompson@mail.utoronto.ca> wrote:

Dr. Vaillancourt:

Toronto Public Health is doing a live human study, teaching the general public chest compressions only for poisoning (drug OD).  See attached CJPH 2013;104(3)e200-4

Omitted from the article Signs & Symptoms of opioid poisoning.  See attached from the training literature

Training Power Point Slide 23   Training power point Slide 23

I know of deaths 14 yr. old juvenile onset diabetes case; 70 yr. old unconscious choking victim plus poisoning (drug OD) deaths.  Responders were doing as instructed, unconscious, cyanotic, laboured breathing, pin point pupils all proves heart is beating patient is dying lack of oxygen, no need to check pulse. Give chest compressions only?

Any comment would be appreciated, I am at a loss understanding this practice.

Thank You & Remember the Mysteries

Gary Thompson

From Laurie Morrison   MorrisonL@smh.ca      Oct 8, 2012

To James Thompson

CC ‘Aaron Orkin (aorkin@gmail.com)’ [note Dr. Orkin co-author 2015 AHA guidelines   My moderated comments Hyperlinks BLS 891 and ALS 441]

Hi James

Yes I helped craft them in accordance with the guidelines and feel the approach to chest compression only is the right way to go for many reasons. Happy to discuss with you at any time.  Aaron Orkin (copied here) and Toronto public Health were more involved than I was as I was just the expert brought in to help out. 

Cell is 4165245434 or we could set up a face to face by email if you prefer. 

Laurie 

From: James Thompson [mailto:jgary.thompson@mail.utoronto.ca]  Sent: Wednesday, October 03, 2012 5:02 PM

To: Laurie Morrison 

Subject: naloxone training 

Dr. Morrison:

I have just found out that RESCU was part of Toronto Public Health’s naloxone protocols.  I think they should be changed, as there is no scientific evidence for chest compressions only in opiate overdose.

See Attached   ILCOR  andAmer Heart Assoc. Guidelines 2010

Please reply ASAP 

Remember the Magic

Gary Thompson @GaryCPR

Dr. Morrison was not happy to discuss when told brining a tape recorder. She phoned the police. Get a phone call “Gary can you come to the station” “Sure be right there” Police constable “Gary I want to shake your hand you have been saving lives, bad news is Dr. Morrison wants no contact.” “Fine by me she is a nut”

Dr. Laurie Morrison Co-Chair AHA & ILCOR Guidelines on toxic ingestions  

2010 AHA Guidelines Part 12.7: http://circ.ahajournals.org/content/122/18_suppl_3/S829.full#sec-80

ILCOR 2010 Part 8.5 Drug Overdose and Poisoning http://www.resuscitationjournal.com/article/S0300-9572(10)00453-3/fulltext#sec2260

UNDOC/WHO 2013 Opioid overdose Page 7 layman’s language https://www.unodc.org/docs/treatment/overdose.pdf

Compressions only CPR AHA Guidelines 2010 Part 4 http://circ.ahajournals.org/content/122/18_suppl_3/S676.full.pdf+html

Received an email Feb. 9th barred from attending the Canadian Emergency Care Conference. See last photo

Walk into the bar just to the left of hotel entrance. Standing at the bar Dr. Laurie Morrison ordering a Mocha. I order a coffee, Dr. Morrison pays $4.25 by credit card. Conversation L.M. “Oh cheaper than Starbucks? (it was a Starbucks).

Me “I use mine to stay awake, are you with the conference?” L.M. “Yes a lot of people here are you enjoying it?” Me “Just got here, was published in Emergency Medicine News and the CPR guidelines” L.M. “very good”

I put the article CJPH 2013;104(3)e200-4 on the bar’s counter, she gives it a glance L.M. “Yes opioid OD and Fentanyl is coming our way” Me “Am just trying to save your life” opened up to page 201  https://jgarythompson.wordpress.com/2016/08/12/response-cjph-20131043e200-4-2/   Dr. Morrison is credited in the article bottom p.200

L.M. “Yes I have seen that before, Halifax Dr.#### (I missed her name) just started doing that” Me “I have talked to Cindy MacIsaac of ‘Direction 180’ Halifax about this” L.M. “Medicine does a lot of crazy things”

Me “We have know for 5,000 years since the invention of opium OD causes you to stop breathing” We go our separate ways, she goes left towards the conference pulls out her phone calls someone”

Me I go out the front door 2-3 minutes later two security guards stand out front. I am on the sidewalk and give them a wave.

On the way home stopped at EMS station Lawrence Ave West and Jane St. Gave them copies of my article and Public Health’s “Just trying to save your life and make your job easier, EMS are the people dealing with patients (mostly non OD’s) damaged with chest compression’s they were never to receive, on a regular basis”

Next day phoned Nicole Pelletier from inside the hotel, she was with Dr. Morrison. Nicole put me on speaker phone gave my usual chat about acute respiratory failure and that I talked to Dr. Morrison at the conference. Twice Nicole asked “Gary do you have proof you talked to Dr. Morrison” replied twice sure I do have it on tape.   Quote Dr. Morrison in the background “Thanks a lot Gary” replied “You are very welcome Dr. Morrison, don’t get in a car accident you may suffer a respiratory emergency and are not very likely to suffer a sudden cardiac arrest, good day.”

dr-morrison-photo-feb22

Thank you Heart & Stroke Foundation for sending me Dr. Orkin’s Power Point and Posting my response on the Heart & Stroke Foundation’s Official site read my comment box

Canadian emergency care conference

popp-program-001

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@GaryCPR

EMN 2015; 37(12):31 http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx Article in the 2015 AHA & ILCOR guidelines 'Opioid OD' https://youtu.be/PX0HQuaNS_I

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