Opioid overdose resident survival guide

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 approach to Opioid overdose

Characterize the symptoms: Abdominal cramps Constipation Difficulty in breathing Drowsiness Dry mouth Stupor Miosis

Examine the patient: Bradypnea/apnea Cyanosis nails and lips Decreased bowel sounds Decreased heart rate Decreased neurological status Hypothermia Miosis Prsence 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

Administer naloxone IV 0.04 mg in adults and 0.1 mg/kg in pediatric patients stat Increase in respiratory rate ?

No

Yes

Administer naloxone IV 0.5 mg Increase in respiratory rate?

Observe

No

Yes

Administer naloxone IV 2 mg Increase in respiratory rate?

Observe

No

Yes

Administer naloxone IV 4 mg Increase in respiratory rate?

Observe

Administer naloxone IV 10 mg Increase in respiratory rate?

Observe