Naloxone recurrent toxicity — DipIMC MCQ

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ModeratePharmacology in Pre-Hospital SettingNaloxone recurrent toxicityDipIMC

A 42-year-old man is found unconscious in a car park with pinpoint pupils and RR 5 after suspected heroin use. After airway positioning and ventilation, his breathing improves briefly after naloxone but then slows again during transfer to the ambulance. What is the most appropriate drug/dose?

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Correct answer: B — Titrate naloxone to adequate breathing and monitor for recurrence

Option B is correct because Naloxone should be titrated to restore adequate ventilation rather than to produce full arousal, and recurrence is common when the opioid lasts longer than naloxone. Giving repeated large doses may precipitate acute withdrawal and agitation, which can worsen scene risk. The clinical target is ventilation, not a normal conversation. Option E is less appropriate because that dose is an ALS cardiac-arrest dose and is unsafe for this non-arrest indication; option D is less appropriate because aspirin is useful in ACS but inappropriate for this presentation. Option C is less appropriate because untitrated opioid dosing can cause avoidable hypotension or respiratory depression; option A is less appropriate because steroids have delayed onset and should not replace the immediate treatment. Clinical pearl: in DipIMC-style questions, the best answer is the intervention that changes outcome earliest in the pre-hospital phase.

Reference: JRCALC Guidelines; Resuscitation Council UK