{"version":"1.0.0","segments":[{"startTime":0.165,"endTime":3.135,"body":"♪ (music) ♪"},{"startTime":3.135,"endTime":5.497,"body":"(Cathy) Hi. Welcome to \u003ci\u003eHarrison's Podclass\u003c/i\u003e"},{"startTime":5.497,"endTime":8.62,"body":"where we discuss important concepts"},{"startTime":5.497,"endTime":8.62,"body":"in internal medicine."},{"startTime":8.62,"endTime":11.05,"body":"- I'm Cathy Handy."},{"startTime":8.62,"endTime":11.05,"body":"- And I'm Charlie Wiener,"},{"startTime":11.052,"endTime":13.9,"body":"and we're coming to you"},{"startTime":11.052,"endTime":13.9,"body":"from the Johns Hopkins School of Medicine."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":19.82,"endTime":23.242,"body":"A 38-year-old Woman"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":19.82,"endTime":23.242,"body":"with Altered Mental Status."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":23.847,"endTime":25.53,"body":"I'll read the question."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":25.53,"endTime":28.995,"body":"A 38-year-old woman is brought"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":25.53,"endTime":28.995,"body":"to the Emergency Department by her spouse"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":28.995,"endTime":31.151,"body":"because of decreased mental status."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":31.151,"endTime":33.104,"body":"She had knee surgery two days ago"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":33.104,"endTime":36.674,"body":"and was prescribed"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":33.104,"endTime":36.674,"body":"oral oxycodone for pain."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":36.674,"endTime":38.106,"body":"Her spouse knows that she finished"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":38.106,"endTime":40.833,"body":"the entire seven-day supply"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":38.106,"endTime":40.833,"body":"during that day."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":40.833,"endTime":43.05,"body":"He denies any seizure activity."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":43.05,"endTime":46.168,"body":"They have no other drugs"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":43.05,"endTime":46.168,"body":"or medications in the house."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":46.168,"endTime":50.434,"body":"The patient is afebrile"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":46.168,"endTime":50.434,"body":"with a blood pressure of 130/75,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":50.434,"endTime":54.483,"body":"a heart rate of 70, and respiratory rate"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":50.434,"endTime":54.483,"body":"of four breaths per minute."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":54.483,"endTime":58.389,"body":"Her O2 saturation is 85% on room air."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":58.389,"endTime":63.182,"body":"She barely responds to painful stimuli,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":58.389,"endTime":63.182,"body":"but moves all four extremities equally."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":63.182,"endTime":65.44,"body":"Before we get to the question"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":63.182,"endTime":65.44,"body":"and the answers, Cathy,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":65.44,"endTime":67.254,"body":"what are you thinking so far?"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":67.254,"endTime":68.34,"body":"(Cathy) What we hear so far"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":68.34,"endTime":70.636,"body":"is that the patient had"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":68.34,"endTime":70.636,"body":"a recent orthopedic procedure"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":70.636,"endTime":74.069,"body":"and she was prescribed oxycodone--"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":70.636,"endTime":74.069,"body":"which is an opioid medication--"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":74.069,"endTime":75.263,"body":"for seven days."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":75.263,"endTime":76.863,"body":"That may be a reasonable duration"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":76.863,"endTime":80.022,"body":"depending on what the expected recovery is"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":76.863,"endTime":80.022,"body":"following her surgery,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":80.022,"endTime":83.471,"body":"but it's clear from the case discussion"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":80.022,"endTime":83.471,"body":"that she took too much of it."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":83.471,"endTime":84.663,"body":"These drugs work centrally"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":84.663,"endTime":88.214,"body":"and can cause significant"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":84.663,"endTime":88.214,"body":"respiratory depression and sedation,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":88.214,"endTime":89.744,"body":"which we hear from her exam"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":89.744,"endTime":92.995,"body":"being that she barely responds"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":89.744,"endTime":92.995,"body":"to painful stimuli."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":92.995,"endTime":95.253,"body":"(Charlie) What do you take"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":92.995,"endTime":95.253,"body":"from her vital signs?"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":95.253,"endTime":97.929,"body":"(Cathy) The most notable vital sign"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":95.253,"endTime":97.929,"body":"is that she's hypoxic,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":97.929,"endTime":101.031,"body":"with an oxygen saturation"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":97.929,"endTime":101.031,"body":"of 85% on room air."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":101.031,"endTime":104.127,"body":"If we heard about that alone"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":101.031,"endTime":104.127,"body":"in a post-operative patient"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":104.127,"endTime":105.882,"body":"after an orthopedic procedure,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":105.882,"endTime":108.433,"body":"pulmonary embolism"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":105.882,"endTime":108.433,"body":"would be high on the differential."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":108.433,"endTime":111.374,"body":"But in her case, we also hear she has"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":108.433,"endTime":111.374,"body":"a very reduced respiratory rate"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":111.374,"endTime":112.595,"body":"at four breaths per minute,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":112.595,"endTime":114.826,"body":"but her blood pressure"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":112.595,"endTime":114.826,"body":"and heart rate are within normal,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":114.826,"endTime":117.861,"body":"and that we wouldn't necessarily expect"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":114.826,"endTime":117.861,"body":"from a pulmonary embolism."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":117.861,"endTime":119.465,"body":"Therefore, I think it's way more likely"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":119.465,"endTime":121.924,"body":"that her hypoxia"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":119.465,"endTime":121.924,"body":"is due to hypoventilation"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":121.924,"endTime":125.402,"body":"and I would expect this to respond"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":121.924,"endTime":125.402,"body":"to supplemental oxygen."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":125.402,"endTime":127.667,"body":"(Charlie) A blood gas"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":125.402,"endTime":127.667,"body":"in this case would be useful"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":127.667,"endTime":130.942,"body":"to distinguish those two,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":127.667,"endTime":130.942,"body":"in that an opioid overdose"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":130.942,"endTime":133.876,"body":"will typically cause"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":130.942,"endTime":133.876,"body":"a respiratory acidosis"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":133.876,"endTime":138.639,"body":"where most cases of pulmonary embolism"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":133.876,"endTime":138.639,"body":"present with a respiratory alkalosis."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":138.639,"endTime":141.342,"body":"So, you suspect an opioid overdose."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":141.342,"endTime":144.414,"body":"So, let's go through the question"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":141.342,"endTime":144.414,"body":"and their answers."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":144.414,"endTime":147.124,"body":"The question asks,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":144.414,"endTime":147.124,"body":"which of the following medications"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":147.124,"endTime":150.212,"body":"is most likely to improve"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":147.124,"endTime":150.212,"body":"her mental status?"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":150.212,"endTime":152.516,"body":"Option A, albuterol;"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":152.516,"endTime":155.221,"body":"option B, alvimopan;"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":155.221,"endTime":157.755,"body":"option C, flumazenil;"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":157.755,"endTime":160.49,"body":"option D, N-acetylcysteine;"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":160.49,"endTime":162.947,"body":"or option E, naloxone."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":162.947,"endTime":166.576,"body":"Which of those will help reverse"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":162.947,"endTime":166.576,"body":"an opioid overdose?"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":166.576,"endTime":169.173,"body":"(Cathy) The antidote"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":166.576,"endTime":169.173,"body":"to opioid overdose is naloxone,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":169.173,"endTime":171.03,"body":"which is an opioid antagonist,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":171.03,"endTime":173.704,"body":"and that can rapidly reverse"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":171.03,"endTime":173.704,"body":"the respiratory depression"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":173.704,"endTime":175.764,"body":"which is causing her hypoventilation,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":175.764,"endTime":179.339,"body":"and also the sedation which is causing"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":175.764,"endTime":179.339,"body":"her decreased mental status."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":179.339,"endTime":180.504,"body":"It's commonly used now"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":180.504,"endTime":183.59,"body":"to treat recreational"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":180.504,"endTime":183.59,"body":"or illicit or narcotic overdoses,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":183.59,"endTime":187.159,"body":"and it can be prescribed to patients"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":183.59,"endTime":187.159,"body":"at a high risk of overdose, too."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":187.159,"endTime":189.41,"body":"The big thing to remember"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":187.159,"endTime":189.41,"body":"is that it's very short-acting,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":189.41,"endTime":192.277,"body":"so she may need repeated doses"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":189.41,"endTime":192.277,"body":"or a naloxone drip"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":192.277,"endTime":194.711,"body":"if the half-life of the medication"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":192.277,"endTime":194.711,"body":"that she took"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":194.711,"endTime":196.775,"body":"is much longer than the antidote."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":196.775,"endTime":199.865,"body":"(Charlie) So the answer"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":196.775,"endTime":199.865,"body":"to this question is D, naloxone--"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":199.865,"endTime":201.557,"body":"that's the medication of the ones listed"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":201.557,"endTime":204.258,"body":"that's most likely to improve"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":201.557,"endTime":204.258,"body":"the mental status of the patient"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":204.258,"endTime":207.035,"body":"with any kind of opioid intoxication."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":207.035,"endTime":208.816,"body":"But what about the other answers, Cathy?"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":208.816,"endTime":210.953,"body":"(Cathy) Well, we'll start"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":208.816,"endTime":210.953,"body":"by just going down the list."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":210.953,"endTime":212.742,"body":"So, albuterol is a beta-agonist"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":212.742,"endTime":214.532,"body":"and that can increase"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":212.742,"endTime":214.532,"body":"the respiratory rate,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":214.532,"endTime":218.472,"body":"but it really won't do anything to help"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":214.532,"endTime":218.472,"body":"the opioid effect causing sedation,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":218.472,"endTime":221.256,"body":"and it really doesn't have a role"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":218.472,"endTime":221.256,"body":"in opioid overdose."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":221.256,"endTime":225.854,"body":"Alvimopan is an oral opioid antagonist,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":221.256,"endTime":225.854,"body":"but it really only works on the gut"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":225.854,"endTime":229.145,"body":"and that's why it's approved for use"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":225.854,"endTime":229.145,"body":"really just following surgeries."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":229.145,"endTime":232.178,"body":"So, it can counteract"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":229.145,"endTime":232.178,"body":"the peripheral side effects of opioids,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":232.178,"endTime":233.621,"body":"such as constipation,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":233.621,"endTime":235.593,"body":"but it really doesn't have"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":233.621,"endTime":235.593,"body":"any central actions."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":235.593,"endTime":236.934,"body":"So, in her case,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":236.934,"endTime":239.255,"body":"where we're most concerned"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":236.934,"endTime":239.255,"body":"about her mental status,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":239.255,"endTime":240.91,"body":"this wouldn't help at all."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":240.91,"endTime":243.61,"body":"Flumazenil is a GABA receptor antagonist,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":243.61,"endTime":245.878,"body":"and that's used"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":243.61,"endTime":245.878,"body":"for benzodiazepine overdose"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":245.878,"endTime":247.778,"body":"such as Valium or Ativan."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":247.778,"endTime":251.085,"body":"A benzo overdose"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":247.778,"endTime":251.085,"body":"would present similarly to this patient,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":251.085,"endTime":253.14,"body":"and the reason that I went"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":251.085,"endTime":253.14,"body":"with narcotic overdose"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":253.14,"endTime":256.766,"body":"is because we heard from the husband"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":253.14,"endTime":256.766,"body":"that she had oxycodone in the house"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":256.766,"endTime":258.778,"body":"and that there were no other medications."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":258.778,"endTime":261.649,"body":"So, it's important to think about"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":258.778,"endTime":261.649,"body":"if there were additional medications"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":261.649,"endTime":263.196,"body":"that the patient may have taken,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":263.196,"endTime":265.046,"body":"but with a good medication history"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":265.046,"endTime":267.485,"body":"and collateral information, too"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":265.046,"endTime":267.485,"body":"from the family,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":267.485,"endTime":270.119,"body":"I don't suspect"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":267.485,"endTime":270.119,"body":"that this is playing a role."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":270.119,"endTime":271.403,"body":"(Charlie) It's important to note"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":271.403,"endTime":274.132,"body":"that flumazenil"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":271.403,"endTime":274.132,"body":"can also precipitate seizures,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":274.132,"endTime":275.984,"body":"so it should be used very cautiously,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":275.984,"endTime":278.515,"body":"and it is typically used"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":275.984,"endTime":278.515,"body":"on in-patients only"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":278.515,"endTime":280.76,"body":"as an IV administration."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":280.76,"endTime":282.982,"body":"What about N-acetylcysteine?"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":282.982,"endTime":286.273,"body":"(Cathy) So, that's used"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":282.982,"endTime":286.273,"body":"for acetaminophen or Tylenol overdose."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":286.273,"endTime":289.087,"body":"And the thing to remember,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":286.273,"endTime":289.087,"body":"especially as it relates to this case,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":289.087,"endTime":292.898,"body":"is that Tylenol or acetaminophen"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":289.087,"endTime":292.898,"body":"is frequently combined with oxycodone"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":292.898,"endTime":297.815,"body":"or opioid medications into one pill,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":292.898,"endTime":297.815,"body":"so there can be unintentional overdoses"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":297.815,"endTime":299.354,"body":"that are possible."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":299.354,"endTime":301.678,"body":"Clinicians should make sure"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":299.354,"endTime":301.678,"body":"to check medication bottles"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":301.678,"endTime":305.588,"body":"or review medication or pharmacy records,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":301.678,"endTime":305.588,"body":"to see if Tylenol or acetaminophen"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":305.588,"endTime":309.13,"body":"was included"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":305.588,"endTime":309.13,"body":"as a combination pill with opioids."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":309.13,"endTime":311.014,"body":"And certainly, if there was any suspicion"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":311.014,"endTime":314.265,"body":"that there was acetaminophen"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":311.014,"endTime":314.265,"body":"combined with the opioid medications,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":314.265,"endTime":317.567,"body":"or if there are any abnormalities"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":314.265,"endTime":317.567,"body":"of liver enzymes on lab work,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":317.567,"endTime":321.303,"body":"then a Tylenol or acetaminophen level"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":317.567,"endTime":321.303,"body":"should be checked."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":321.303,"endTime":323.388,"body":"(Charlie) It's so easy"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":321.303,"endTime":323.388,"body":"to check one of those levels,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":323.388,"endTime":325.394,"body":"that I think any patient"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":323.388,"endTime":325.394,"body":"with a suspected overdose,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":325.394,"endTime":327.272,"body":"it's worth just checking anyway."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":327.272,"endTime":328.853,"body":"So, the teaching point in this case"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":328.853,"endTime":332.981,"body":"is that opioids can cause"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":328.853,"endTime":332.981,"body":"respiratory depression, hypoxemia,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":332.981,"endTime":336.515,"body":"possibly with concurrent hypercarbia"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":332.981,"endTime":336.515,"body":"if checked by blood gas,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":336.515,"endTime":337.693,"body":"and those can be reversed"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":337.693,"endTime":340.592,"body":"with the short-acting"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":337.693,"endTime":340.592,"body":"antagonist, naloxone."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":340.592,"endTime":342.76,"body":"In addition, clinicians"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":340.592,"endTime":342.76,"body":"should be very careful"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":342.76,"endTime":345.439,"body":"to elicit an accurate medication history"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":345.439,"endTime":347.906,"body":"to make sure"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":345.439,"endTime":347.906,"body":"there are no other co-ingestions"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":347.906,"endTime":351.039,"body":"that could be contributing"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":347.906,"endTime":351.039,"body":"to the presentation."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":351.039,"endTime":352.204,"body":"(Cathy) For more information,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":352.204,"endTime":354.923,"body":"check out Harrison's Internal Medicine"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":352.204,"endTime":354.923,"body":"chapter on pain:"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":354.923,"endTime":356.823,"body":"The Pathophysiology and Management,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":356.823,"endTime":360.157,"body":"or the online chapter"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":356.823,"endTime":360.157,"body":"on opioid-related disorders."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":360.157,"endTime":362.676,"body":"I'd also suggest taking a look"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":360.157,"endTime":362.676,"body":"at the SPACE trial,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":362.676,"endTime":365.47,"body":"which was published recently"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":362.676,"endTime":365.47,"body":"in 2018 in JAMA,"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":365.47,"endTime":366.777,"body":"which suggests that opioids"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":366.777,"endTime":369.219,"body":"may not be better"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":366.777,"endTime":369.219,"body":"than non-opioid pain medications"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":369.219,"endTime":372.397,"body":"in controlling chronic pain"},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":369.219,"endTime":372.397,"body":"from osteoarthritis."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":373.147,"endTime":375.27,"body":"(Charlie) Okay, we'll see you next week."},{"speaker":"Welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e Episode 5","startTime":375.27,"endTime":377.79,"body":"♪ (music) ♪"}]}