Disposition Outcomes Following Prehospital Use of Naloxone in a Large Metropolitan City in the United States.

OBJECTIVES: During a drug overdose, research suggests individuals may not call 9-1-1 out of fear of criminal justice concerns. Of those that call, research is inconclusive about the disposition of the emergency transport. We evaluated transport outcomes for adults with opioid-related overdose in the Emergency Medical Services (EMS) of a large metropolitan city in the United States. METHODS: We reviewed the EMS incident report database from the patient care record system for years 2018 to 2022. We queried all records, searching for relevant terms, and two reviewers cross-checked the database to identify cases that did not result in death at the scene. Study outcome was defined as hospital transportation or no transportation. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for hospital transport with patient age, sex, race and ethnicity as the independent variables. RESULTS: We identified 5,482 cases of nonfatal opioid-related overdose. Of these, 4,984 (90.9%) were transported to the hospital; 37 (0.7%) were placed in police custody; 304 (5.5%) were not transferred; and 157 (2.9%) had unknown outcomes. Among 5,288 with data on the transport outcome, the majority were male (65%), and the highest proportion were White (39%). Compared to those who were not transported, each 1-year increase in age was related to a 2% increase in the odds of transportation (OR: 1.02, 95% CI: 1.01-1.02). Compared to White patients, Black and Hispanic patients were 43% OR: 1.43, 95% CI: 1.07-1.90) and 44% (OR: 1.44, 95% CI: 1.03-2.00) more likely to be transported. CONCLUSIONS: Individuals with suspected opioid-related overdose who call 9-1-1 are most often transported to the hospital. Current EMS procedures are successful at on-scene treatment and transportation; however, data on the long-term impact of opioid-related overdoses are still needed.

Unusual Clinical Presentation of Nephrotic Syndrome With Significant Renal Vein Thrombosis in a Young Male: A Case Report and Literature Review.

Primary membranous glomerulopathy is the most common cause of idiopathic nephrotic syndrome, with increasing recognition as an autoimmune-mediated disease. We present the case of a 31-year-old Hispanic male with no prior medical or family history, presenting with one month of dyspnea on exertion, lower extremity, and periorbital edema with a recent diagnosis of pulmonary embolism. Upon further imaging, renal vein thrombosis was discovered with significant lab dysfunction concerning nephrotic syndrome. Further, a workup of kidney biopsy and serum antibody levels revealed the cause to be anti-phospholipase A2 receptor (PLA2R)-mediated.