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Opiate respiratory arrest — DipIMC MCQ

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ModerateResuscitationOpiate respiratory arrestDipIMC

A 36-year-old is cyanosed with pinpoint pupils and respiratory rate 4/min after suspected heroin use. A carotid pulse is present. What is the most appropriate drug/dose?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: ANaloxone titrated to restore breathing

Explanation lettering: C = shown as B · E = shown as C · B = shown as E

A is correct: In opioid toxicity with a pulse, naloxone is titrated to restore ventilation rather than to produce abrupt full arousal. B is less suitable because the dose is below standard severe adult asthma nebuliser dosing; C is less suitable because cardiac-arrest adrenaline dosing is inappropriate in a perfusing patient; D is less suitable because a large initial opioid bolus risks hypotension and respiratory depression; E is less suitable because analgesia is important but does not replace the first physiological intervention. The most tempting alternative is therefore suboptimal because it either delays the time-critical pre-hospital intervention or sends the patient to the wrong level of care. The key DipIMC principle is focused cABCDE decision-making with early pre-alert, triage or retrieval escalation when the scene physiology demands it.

Reference: Resuscitation Council UK Guidelines 2025; JRCALC Guidelines