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CT of head without contrast
27%
12/45
Forced air warmer
0%
0/45
Intranasal naloxone
42%
19/45
Intubation
22%
10/45
Orange juice by mouth
2%
1/45
Select Answer to see Preferred Response
This postoperative patient with miosis, sedation, and bradypnea raises concern for opioid overdose. Intranasal naloxone is the most appropriate next step in management for a patient with opioid overdose.Opioid overdose is a common cause of death. Mu agonism by opioids mediates analgesia but also respiratory depression, which can lead to hypercapnic respiratory failure. Other symptoms and signs include constipation, pupillary constriction, and complications of intravenous drug use, including endocarditis. Naloxone is a mu-receptor antagonist that can be administered through multiple routes of administration, including oral, intravenous, intranasal, intramuscular, sublingual, and subcutaneous. A postoperative patient with bradypnea should raise concerns about opioid overdose and should be initially managed with naloxone. Van Dorp et al. review the evidence regarding the diagnosis and treatment of patients with opioid overdose and addiction. They discuss how naloxone is used in order to reverse the opioid intoxication. They recommend monitoring the patient carefully in order to prevent withdrawal phenomena.Incorrect Answers:Answer 1: CT of the head without contrast would be appropriate if the patient had focal unilateral findings or if naloxone does not improve mental status. This would allow for detection of the strokes, bleeds, and other intracranial pathologies.Answer 2: A forced air warmer is excellent for addressing hypothermia but does not treat the underlying condition. Patients who are acutely intoxicated with opioids require reversal with naloxone if they are not protecting their airway.Answer 4: Intubation should be considered if the patient's mental status remains altered or they are not oxygenating or ventilating adequately.Answer 5: Orange juice by mouth is appropriate for a hypoglycemic patient who can protect their airway. Rapid correction of hypoglycemia in confusion or stroke may resolve symptoms.Bullet Summary:Naloxone is the treatment of choice for an opioid overdose.
4.1
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