Opioid overdose
History/questionnaire:
Known opioid addict?
Chronic user after a period of abstinence?
Long-term user who
- became acutely unwell?
- lost weight?
- had a declining renal function?
Concurrent gabapentinoid and opioid co-prescription with synergistic effects?
Past medical history?
Current medication?
Known drug allergies?
Examination:
Respiratory rate?
- ≤12 breaths/minute?
Miosis (excessive constriction of pupils)?
Circumstantial evidence of opioid abuse?
CNS depression?
Relative bradycardia?
Opioid patches?
Track marks on arms/legs?
Groin sinuses?
Management:
Acute OD in an opioid user?
-> Referred to hospital?
Palliative care setting?
-> Discussed with local palliative care team/hospice advice line?
Supported airways and breathing (esp. in patients with stupor and RR ≤12 breaths/minute)?
Maintained airway through chin-lift/head-tilt or jaw-thrust manoeuvres?
Considered simple airways adjunct (oro or nasopharyngeal airway)?
Shouted and shook, tried to stimulate?
Additional ventilatory support with a bag-valve mask and supplemental oxygen to maintain oxygen saturations between 94% and 98%?
Therapeutic trial of naloxone (duration of effect 30-90 minutes)?
- 400 mcg if respiratory or cardiac arrest (large rapid doses for respiratory arrest, otherwise to give 400 mcg into 10 ml syringe with saline and to give 3 ml every minute until satisfactory response and if no response by a total of 2 mg to give a further 2 mg and if still no response to consider an alternative diagnosis)?
- 2 mg IM if respiratory arrest?
- 1.8 mg as nasal spray?
- 100 mcg/kg (max 2 mg per dose) if respiratory arrest in children under 12 years, if no response, repeat at intervals of 1 minutes to a total max. of 2 mg (> 12 years as adult dose)Acute OD in an opioid user?
-> Referred to hospital?
Palliative care setting?
-> Discussed with local palliative care team/hospice advice line?
Reference(s):