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Opioid overdose with respiratory depression — SCE Acute Medicine MCQ

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HardToxicology and OverdoseOpioid overdose with respiratory depressionSCE Acute Medicine

A patient dependent on opioids has respiratory rate 5/min and pinpoint pupils after heroin use. Bag-mask ventilation and oxygen are underway. Which naloxone strategy is most appropriate?

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

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Correct answer: A — Titrate intravenous naloxone to restore ventilation

The best answer is “Titrate intravenous naloxone to restore ventilation”. This is correct because the therapeutic endpoint is adequate breathing and airway protection. Large boluses can precipitate severe withdrawal, agitation, vomiting and recurrent toxicity when naloxone wears off. Ventilation complements rather than replaces antidote use, flumazenil targets benzodiazepines, and laboratory confirmation must not delay treatment.

Reference: Resuscitation Council UK special-circumstances guidance: https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/adult-advanced-life-support-guidelines