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Recurrent opioid toxicity — RCPSC EM MCQ

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HardToxicologyRecurrent opioid toxicityRCPSC EM

After fentanyl exposure, a patient initially responds to naloxone. Two hours later, RR is 6/min and oxygen saturation is 84% with no trauma or hypoglycaemia. What is the next management step?

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Correct answer: C — Restart naloxone and begin a titrated infusion

The best answer is “Restart naloxone and begin a titrated infusion”. Recurrent respiratory depression after naloxone is expected when opioid effect outlasts the antagonist. Ventilation comes first, naloxone is titrated to adequate breathing rather than complete wakefulness, and repeated-dose recurrence is an indication for infusion and monitored observation. Flumazenil neither reverses opioids nor is routinely safe in unknown exposure.

Reference: Emergency Care BC: Opioid Poisoning—In-Hospital Management: https://emergencycarebc.ca/clinical_resource/clinical-summary/opioid-poisoning-in-hospital-management/