Opioid overdose resident survival guide: Difference between revisions

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==References==
==References==
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Revision as of 18:44, 13 February 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Vidit Bhargava, M.B.B.S [2]

Definition

Opioid overdose is defined as an acute condition due to excessive use of opioids/narcotics.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Opioid overdose is by itself life threatening and should be treated as such irrespective of the causes.

Common Causes

  • Accidental overdose
  • Simultaneous use with other illicit drugs, sedative hypnotics
  • Rupture of package inside body cavity in body packers, body stuffers

Management

Shown below is an algorithm summarizing the diagnostic approach to Opioid overdose:

 
 
 
 
 
 
 
Characterize the symptoms:
❑ Abdominal cramps
❑ Constipation
❑ Difficulty in breathing
❑ Drowsiness
❑ Dry mouth
❑ Stupor
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient:
Bradypnea/apnea
❑ Cyanosis nails and lips
❑ Decreased bowel sounds
❑ Decreased heart rate
❑ Decreased neurological status
❑ Hypothermia
❑ Miosis
❑ Presence of one or more fentanyl patches
Shallow and deep respiration
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider alternative diagnosis:
❑ Gammahydroxybutyrate/gammabutyrolactone overdose
❑ Alcohol intoxication
❑ Sedative hypnotics
❑ Phencyclidine (PCP) overdose
❑ Ketamine overdose
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diagnostic triad: (not present in all the cases)
❑ Miosis
❑ Respiratory depression
❑ Stupor
 
 
 
 


Shown below is an alogorithm summarizing the basic approach to naloxone (Narcan) administration:


 
 
 
 
 
 
 
Administer naloxone IV 0.04 mg in adults and
0.1 mg/kg in pediatric patients stat
Increase in respiratory rate ?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
Observe
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Administer additional naloxone IV 0.5 mg
Increase in respiratory rate?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
Observe
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Administer additional naloxone IV 2 mg
Increase in respiratory rate?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
Observe
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Administer additional naloxone IV 4 mg
Increase in respiratory rate?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
Observe
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Administer additional naloxone IV 10 mg
Increase in respiratory rate?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
Observe
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Administer additional naloxone IV 15 mg
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Further management
 
 
 
 


Shown below is an algorithm summarizing the comprehensive approach to ICU management of patients with opioid overdose:[1]


 
 
 
 
 
Opioid overdose: Respiratory rate < 12/min
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Oxygenate with bag and mask, administer naloxone with a gradually increasing dose till reversal of respiratory depression is seen
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History of use of morphine, fentanyl or other long acting opioids?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Admit to ICU
 
 
 
Observe for 4-6 hours after last naloxone dose
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patient fully awake and alert ?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform intubation, begin a continuous naloxone infusion
 
Admit to ICU
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Continue infusion till respiratory depression reversed, observe 4-6 hours after naloxone infusion is stopped
 
 
 
 
 
Discharge patient, when awake & alert with stable vital signs
 
 
 
 
 
 

References

  1. Boyer, EW. (2012). "Management of opioid analgesic overdose". N Engl J Med. 367 (2): 146–55. doi:10.1056/NEJMra1202561. PMID 22784117. Unknown parameter |month= ignored (help)