Recognize the Opioid Toxidrome
The classic signs of opioid overdose are decreased level of consciousness, slow or absent respirations, and pinpoint pupils. Hypoxia is the main cause of death, not the drug itself. Ventilation with a bag-valve mask is the first and most important treatment.
How Naloxone Works
Naloxone is a competitive opioid antagonist that displaces opioids from receptors. It can be given intranasally, intramuscularly, intravenously, or via auto-injector. Typical starting doses are 0.4 to 2 mg, titrated to adequate respirations.
Watch for Complications
Rapid reversal can cause vomiting, agitation, and acute withdrawal, which puts the crew at risk. Naloxone has a shorter half-life than many opioids, so patients can re-sedate. Always transport patients who received naloxone and continue monitoring ventilation.