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The assigned case describes a patient with a history of substance abuse who was treated by EMS following an opioid overdose. The patient complained of burning pain in his hip and forearm. Upon examination, these areas revealed a large amount of necrotic tissue. The patient also had hyperkalemia with a serum potassium level of 6.9m Eq/L. The symptoms described in the case suggest that the patient has rhabdomyolysis.
This condition involves the rapid dissolution of skeletal muscle due to damage or injury (Torres et al., 2015). It is potentially life-threatening as it leads to ” the release of cell components like myoglobin, creatine kinase (CK), lactate dehydrogenase and potassium into circulation” (Stahl, Rastelli, & Schoser, 2020, p. 877).
Drug use is among the causes of the development of rhabdomyolysis. However, the condition is tied to various other causes, including traumatic injury, infections, muscle ischemia, metabolic, and genetic disorders (Torres et al., 2015). Genetic factors that contribute to the development of rhabdomyolysis include metabolic muscle disorders, mitochondrial disorders, muscular dystrophies, and conditions impairing intramuscular calcium release and excitation-contraction coupling (Scalco et al., 2015). Hence, genetics plays a role in the development of rhabdomyolysis because certain genetic illnesses can increase the patient’s risk of rhabdomyolysis and contribute to its development.
The patient’s symptoms are associated with opioid overdose, as well as with rhabdomyolysis. On the one hand, opioid overdose caused depression of breathing, leading to unconsciousness, which are both signs of the condition (Substance Abuse and Mental Health Services Administration, 2018).
On the other hand, rhabdomyolysis was associated with burning pain in the extremities since myalgia, muscle weakness, and dark urine are the classic clinical triad of rhabdomyolysis (Stahl, Rastelli, & Schoser, 2020). Myalgia, in this case, was caused by the destruction of muscle tissue in the area and the release of cell components into the bloodstream.
As part of EMS treatment, naloxone was administered, causing the patient to become responsive again. This physiologic response to the stimulus is tied to the effect that naloxone has on the body following an opioid overdose. Naloxone reverses the impact of opioids on the body, thus resolving respiratory depression and restoring breathing and consciousness (SAMHSA, 2018). The cells involved in this process are nerve cells that contain opioid receptors. Naloxone displaces opioids from these receptors, thus reversing its effect on the body (SAMHSA, 2018). For this reason, treatment with naloxone is appropriate for all cases of an opioid overdose.
Based on scholarly evidence and discussion, the response of EMS was appropriate to the situation. The paramedics administered naloxone to restore breathing and consciousness in the patient, but they did not assess him for rhabdomyolysis at first since he was unresponsive and could not describe the symptoms. The response to complaints about burning pain in the muscles would have been different if the patient was conscious and had a genetic condition associated with an increased risk of rhabdomyolysis. In this case, immediate muscle tissue assessment would have been performed to avoid continued damage to the body.
On the whole, the case describes an incident of rhabdomyolysis caused by an opioid overdose. Rhabdomyolysis is a serious condition involving damage to muscle tissue and leading to the release of cell components into the bloodstream, which is why it is potentially life-threatening. The condition can be caused by genetic factors, including metabolic, mitochondrial, and muscle tissue disorders. Hence, patients who are genetically predisposed to rhabdomyolysis should be assessed for it immediately following a high-risk event.
References
Scalco, R. S., Gardiner, A. R., Pitceathly, R. D., Zanoteli, E., Becker, J., Holton, J. L., Houlden, H., Jungbluth, H., & Quinlivan, R. (2015). Rhabdomyolysis: a genetic perspective. Orphanet Journal of Rare Diseases, 10(1), 51-65.
Stahl, K., Rastelli, E., & Schoser, B. (2020). A systematic review on the definition of rhabdomyolysis. Journal of Neurology, 267(4), 877-882.
Substance Abuse and Mental Health Services Administration. (2018). Opioid overdose prevention toolkit. Web.
Torres, P. A., Helmstetter, J. A., Kaye, A. M., & Kaye, A. D. (2015). Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner Journal, 15(1), 58-69.
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