Overdose - Opioids

Question 1

What should the “Other Opioid Overdose” arm of this CPG be used for? (4)

Answer 1

1. Prescription opioid medication overdose
   eg. oxycodone, morphine, codeine, norspan, methadone
2. Iatrogenic opioid overdose
3. Polypharmacy overdose involving opioids
   eg. methamphetamine and heroin
4. Unknown cause of opioid overdose (heroin not suspected)

Question 2

What is the aim of the “Other Opioid Overdose” arm of the CPG?

Answer 2

Titrated Naloxone doses to target the return of adequate ventilation.
Complete reversal of symptoms is not advised.

Question 3

Which opioids may require higher doses of Naloxone to reverse their effects?

Answer 3

Synthetic opioids, especially Fentanyl analogues.

Question 4

Under either opioid guideline, if inadequate response after ____ minutes, the patient is likely to require…?

Answer 4

10 mins.

Transport without delay.

Question 5

What are the two STOP notes under the opioid guideline?

Answer 5

1. Ensure personal/crew safety

2. Scene may have concealed syringes

Question 6

What are the 3 ASSESS points under the opioid guideline?

Answer 6

1. Exclude other causes of ALOC
2. Confirm clinical signs of opioid OD
3. Assess most likely substances involved

Question 7

For a Heroin Overdose what is the management?

Answer 7

1. Maintain airway/ventilation (preoxygenate!!)

2. Naloxone 1.6mg - 2mg IM

Question 8

If, after ____ minutes, inadequately responds, how is a Heroin Overdose managed?

Answer 8

10.
Tx without delay.
No further Naloxone.
Consider airway Mx with SGA.

Question 9

If adequately responds, how is a Heroin Overdose managed?

Answer 9

Consider Tx.

If pt presents with an isolated heroin overdose, and has responded to Naloxone with full recovery, consider TnR.

Question 10

For an Other Opioid Overdose, what is the management?

Answer 10

1. Maintain airway/ventilation (preoxygenate!!)
2. Naloxone 100mcg IV
   - Rpt every 2 mins, max. 2mg until pt adequately self-ventilating
   If unable to insert IV, Naloxone 400mcg IM (once only)
3. Consider airway Mx with SGA.
4. Tx without delay.

Question 11

What is the benefit of requesting MICA in Opioid Overdoses?

Answer 11

Advanced airway Mx.