Opioid Toxicity

Question 1

What percentage of patients may exhibit aggression following naloxone administration?

Answer 1

67%

This statistic highlights the potential behavioral reactions to naloxone in opioid toxicity cases.

Question 2

What are the two criteria indicating opioid toxicity?

Answer 2

Unable to maintain airway OR SpO2 < 92% on room air

These criteria help identify patients in need of immediate intervention.

Question 3

What is the initial dose of naloxone for adult uncomplicated IV opioid toxicity?

Answer 3

800 mcg IM

This is the starting dose for reversing opioid effects in an uncomplicated case.

Question 4

What should be done if a patient shows an adequate response to naloxone?

Answer 4

Consider referral

Referral to higher care may be necessary depending on the patient’s condition.

Question 5

What actions are recommended if there is an inadequate response to naloxone in adult uncomplicated IV opioid toxicity?

Answer 5

Transport, Consider SGA, Consider ETT

These steps ensure the patient receives further medical care and airway management.

Question 6

What are examples of complex opioid toxicity?

Answer 6

• Prescription opioids
• Polydrug toxicity
• Iatrogenic (secondary to opioid analgesia)
• Unknown cause

Understanding complexity helps in tailoring the treatment approach.

Question 7

What is the initial dose of naloxone for adult complex opioid toxicity?

Answer 7

100 mcg IV

This dose is specifically used for more complicated cases of opioid overdose.

Question 8

How often should naloxone be repeated for adult complex opioid toxicity?

Answer 8

At 2 minutes intervals (max. 2000 mcg)

This protocol allows for close monitoring and adjustment based on patient response.

Question 9

What saturation level is considered acceptable in advanced ventilation care?

Answer 9

SAT of - 1

This indicates a permissible range for oxygen saturation during advanced airway management.

Question 10

What should be done if there is no IV access in adult complex opioid toxicity?

Answer 10

Naloxone 400 mcg IM (single dose)

Administering naloxone IM is a critical alternative when IV access is not available.

Question 11

What considerations should be made in adult complex opioid toxicity management?

Answer 11

Consider SGA, Consider ETT

These considerations are vital for ensuring adequate airway management in complex cases.

Question 12

What is the naloxone dosage for opioid-naive paediatric patients IM?

Answer 12

Naloxone 10 mcg / kg IM (max. 800 mcg)

Repeat once at 10 minutes if required.

Question 13

What is the naloxone dosage for opioid-naive paediatric patients IV?

Answer 13

Naloxone 10 mcg / kg IV (max. 100 mcg)

Repeat at 2 minutes intervals.

Question 14

What is the naloxone dosage for opioid-dependent paediatric patients IM?

Answer 14

Naloxone 1 - 2 mcg / kg IM (max. 100 mcg)

Repeat once at 10 minutes if required.

Question 15

What is the naloxone dosage for opioid-dependent paediatric patients IV?

Answer 15

Naloxone 1 - 2 mcg / kg IV (max. 100 mcg)

Repeat at 2 minutes intervals.

Question 16

What are the transport criteria for paediatric patients?

Answer 16

Transport if any of the following are present:
- Unable to maintain airway
- SpO2 < 92% on room air
- Age < 16 OR > 65
- Suspected aspiration
- APO
- Incomplete response to two doses of naloxone
- Suspected opioid other than heroin including synthetic opioids
- Pregnancy.

Question 17

What should be monitored during transport?

Answer 17

Monitor vital signs and SpO2.

Nasal capnography may be used with borderline respiratory values.

Question 18

What are the referral criteria for paediatric patients?

Answer 18

Refer if ALL of the following are present:
- IV opioid only
- Normal vital signs including GCS 15
- SpO2 ≥ 92% on room air.