Opioid Toxicity Medical Directive

Question 1

Opioid Toxicity MD

What are the indications for the opioid toxicity MD?

Answer 1

Altered LOC;
AND
Respiratory depression;
AND
Inability to adequately ventilate OR persistent need to assist ventilations;
AND
Suspected opioid overdose.

Question 2

Opioid Toxicity MD

What are the indications for the opioid toxicity MD?

Answer 2

Altered LOC;
AND
Respiratory depression;
AND
Inability to adequately ventilate OR persistent need to assist ventilations;
AND
Suspected opioid overdose.

Question 3

Opioid Toxicity MD

What are the conditions for naloxone administration?

Answer 3

Age: ≥24 hours
LOA: Altered
RR: <10 breaths/min

Question 4

Opioid Toxicity MD

What are the contraindications to naloxone administration?

Answer 4

Allergy or sensitivity to naloxone

Question 5

Opioid Toxicity MD

What is the order of preference for naloxone administration?

Answer 5

IV/IM/IN/SC

Question 6

Opioid Toxicity MD

What is the dose for naloxone IV?

Answer 6

Up to 0.4 mg, dosing interval 5 min, max 3 doses. (Titrate to restore respiratory status only)

Question 7

Opioid Toxicity MD

What is the dose for naloxone IM?

Answer 7

0.4 mg, dosing interval 5 min, max 3 doses.

Question 8

Opioid Toxicity MD

What is the dose for naloxone IN?

Answer 8

2-4 mg, dosing interval 5 min, max 3 doses. (Divide dose between nares)

Question 9

Opioid Toxicity MD

What is the dose for naloxone SC?

Answer 9

0.8 mg, dosing interval 5 min, max 3 doses.

Question 10

Opioid Toxicity MD

If the patient doesn’t respond to airway management and the administration of naloxone, what should be considered?

Answer 10

Glucometry.

Question 11

Opioid Toxicity MD

Can we patch for more doses?

Answer 11

Yes.

Question 12

Opioid Toxicity MD

What kind of behaviour should be anticipated after naloxone administration?

Answer 12

Combative behaviour should be anticipated following naloxone administration, and paramedics should protect themselves accordingly, thus the importance of gradual titrations (if given IV) to desired clinical effect: respiratory rate ≥10, adequate airway and ventilation, not full alertness.