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Nearly 80,000 Americans died as a result of an opioid overdose in 2023.
Source: Centers for Disease Control
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| Indication | Signs and Symptoms | Medication | Dosage & Route |
|---|---|---|---|
Seizures | GTCS Loss of consciousness Muscle rigidity, possible cyanosis of mucous membranes Jerking movements of limbs Noisy breathing Frothing at mouth (may be pink/red if tongue bitten) | Oxygen | Oxygen (15 liters/minute flow) |
Unconsciousness | Unintended loss of consciousness following CNS-depressant administration (e.g. benzodiazepine) Airway obstruction (tongue) common Inability to maintain a patent airway Snoring | Oxygen Flumazenil | Oxygen (15 liters/minute flow) If benzodiazepine, and if IV route available, flumazenil (0.2 mg IV, repeated Q1 minute) to a maximum of 1 mg over 5 minutes). |
Unconsciousness | Unintended loss of consciousness following opioid (narcotic) administration Respiratory depression common (decreased rate of breathing) Inability to maintain a patent airway Snoring | Oxygen Naloxone | If IV route available, naloxone (0.4 mg IV, every 2 to 3 minutes PRN to a total dose of 10 mg) If no IV available - IN naloxone (1 spray IN [4 mg], repeat every 2 to 3 minutes in alternating nostrils PRN) |
Position supine with feet elevated slightly.
Protect victim from injury.
Gently hold the patient’s arms and legs during the seizure, however do not restrain them with excessive force. Do not put anything in victim’s mouth.
Contact EMS.
Place victim in recovery position.
When convulsions have ceased, place the victim in a recovery position by turning them onto their right side, if possible.
Provide oxygen.
Deliver oxygen at a rate of 15 liters per minute to the patient.
Access CAB: Compressions, Airway and Breathing.
A clear airway is critical. Ensure their head is tilted and their chin is lifted.
Monitor and record patient vital signs.
Position supine with feet elevated slightly.
For dentists, you may keep the patient seated if in a dental chair. In all cases, position them supine with their feet elevated.
Use CAB as necessary.
Initiate compressions, airway and breathing as necessary to resuscitate the patient.
Monitor and record patient vital signs.
For benzodiazepine overdoses and if IV route is available, administer flumazenil.
Administer flumazenil (0.2 mg IV, repeated Q1 minute) to a maximum of 1 mg over 5 minutes.
Monitor patient for the next two hours.
Consider EMS.
Although not required if the patient is recovering, consider contacting EMS to ensure they get proper care.
Position supine with feet elevated slightly.
Use CAB as necessary.
Initiate compressions, airway and breathing as necessary to resuscitate the patient.
Provide oxygen.
Deliver oxygen at a rate of 15 liters per minute to the patient.
Monitor and record patient vital signs.
Check important vital signs, including BP, O₂ saturation, and respiratory rate.
If IV route is available, select a vial of naloxone.
Administer naloxone (0.4 mg IV, every 2 to 3 minutes PRN to a total dose of 10 mg).
If IV route is not available, select intranasal naloxone spray.
Consider EMS.
Get the Guide: Management of Medical Emergencies by Dr. Stanley Malamed, DDS
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