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Opioid overdose — DIPIMC MCQ

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ModerateMedical EmergenciesOpioid overdoseDIPIMCDipIMC

A young man is found unresponsive with pinpoint pupils and a respiratory rate of 5 per minute. Drug paraphernalia is nearby. You support his ventilation with a bag-valve-mask. What is the most appropriate use of naloxone?

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Correct answer: B — Titrate naloxone in small incremental doses to restore adequate breathing

Naloxone is titrated in small incremental doses to restore adequate ventilation rather than full alertness, minimising acute withdrawal and agitation while treating the life-threatening respiratory depression. A large bolus can precipitate severe withdrawal and combative behaviour, and ventilation alone does not address the underlying toxicity. Because naloxone is shorter-acting than many opioids, the patient must be observed for recurrence. Pearl: the aim is a breathing patient, not necessarily a fully awake one.

Reference: JRCALC Clinical Guidelines; TOXBASE