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Oral glucose bolus
0%
0/24
Urine Toxicology
8%
2/24
Insulin Aspart
4%
1/24
Naloxone
79%
19/24
Initiate CPR
Select Answer to see Preferred Response
This patient is exhibiting signs and symptoms of opioid overdose. The appropriate next step in management is administration of naloxone. The signs and symptoms of opioid overdose include miosis ("pinpoint pupils"), nausea, vomiting, respiratory depression, depressed consciousness, and seizures. Naloxone is an opioid antagonist and the drug of choice in the event of an opiod overdose. Keep in mind, however, that naloxone administration can precipitate opiate withdrawal in the habituated patient. Therefore, use the lowest amount that restores acceptable ventilation and mental status. Bowman et al. review the health consequences of opioid addiction in primary care, noting that addiction is prevalent and increasing largely due to an increase in prescription opioids. The authors recommend the use of several screening and intervention tools to identify and assist patients at risk for opioid abuse. They also recommend providing addicted patients with clean syringes and naloxone prescriptions for overdose prevention. Siegler et al. review the unintentional opioid overdose deaths in New York City between 2005 and 2010. Overall, 2649 opioid overdose deaths were reported in this period, with 3/4 of these deaths occurring at home, 1/10 in an institution, and the remaining in a public setting. Because the majority of opioid overdoses occurred at home, the authors recommend targeting the lay audience with opioid overdose response training, including prescriptions of take-home naloxone. Figure A is a photograph of an eye with a severely miotic pupil, as one might see in opioid overdose. Illustration A is an artist's rendering explaining the difference between agonism, partial agonism, and antagonism at the opioid receptor. Incorrect Answers: Answer 1: This patient is not hypoglycemic, therefore he does not need a glucose bolus. Answer 2: While urine toxicology may show high levels of opioid metabolites or perhaps other drugs of abuse, this is not the most appropriate next step in resuscitating the patient. Answer 3: Insulin aspart would be the appropriate next step if this patient was in a NHHS, but it is not helpful for opioid overdose. Answer 5: This patient still has a pulse and is breathing (albeit slowly), so CPR would not be appropriate.
4.3
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