Opioid-Associated Emergencies & Naloxone Flashcards

Which triad of signs is classically associated with opioid overdose?

Answer: Pinpoint pupils, unconsciousness, and respiratory depression

The classic opioid toxidrome is pinpoint (miotic) pupils, decreased consciousness, and respiratory depression, which can lead to respiratory arrest.

What is the primary BLS intervention for an unresponsive victim of suspected opioid overdose who is not breathing normally?

Answer: Give rescue breaths only and monitor for pulse

Opioid overdose typically causes respiratory arrest before cardiac arrest, so rescue breathing (ventilation) is the priority intervention.

Naloxone (Narcan) works by:

Answer: Binding to opioid receptors and reversing opioid effects

Naloxone is a competitive opioid antagonist that displaces opioids from their receptors, rapidly reversing respiratory depression, sedation, and analgesia.

What is the recommended initial intranasal dose of naloxone for an adult opioid emergency in the community setting?

Answer: 2 mg

Current AHA guidelines recommend 2 mg intranasal naloxone as the standard community dose for opioid-associated emergencies in adults.

After giving naloxone to a victim of opioid overdose, if there is no response after 2–3 minutes, you should:

Answer: Give an additional dose of naloxone

If the victim does not respond to the initial naloxone dose within 2–3 minutes, an additional dose may be administered while continuing supportive care.

Why is it critical to call 911 even if a victim responds well to naloxone?

Answer: Naloxone has a shorter duration of action than most opioids, so overdose can recur

Naloxone's effects last only 30–90 minutes, which is shorter than most opioids; re-sedation and respiratory depression can return when naloxone wears off.

Which route of naloxone administration is most commonly available to bystanders and trained lay rescuers?

Answer: Intranasal (IN) spray device

Intranasal naloxone spray (e.g., Narcan nasal spray) is widely available over-the-counter and does not require needles, making it the most practical option for bystanders.

Opioid-associated cardiac arrest is best described as primarily:

Answer: A hypoxic arrest preceded by respiratory failure

Opioids cause respiratory depression leading to hypoxia, which then triggers cardiac arrest; this means effective ventilation is the most critical BLS intervention.

A lay rescuer finds an unresponsive person and calls 911. The dispatcher confirms suspected opioid overdose and informs the rescuer that naloxone is in a nearby kit. The victim is breathing 3 times per minute. What should the rescuer do NEXT?

Answer: Administer naloxone and give rescue breaths

With inadequate breathing (agonal respirations) and available naloxone, the rescuer should administer naloxone and provide rescue breathing to prevent respiratory arrest.

The 2020 AHA BLS guidelines recommend that rescuers in non-medical settings who witness opioid overdose should:

Answer: Administer naloxone and provide rescue breathing as key interventions

AHA guidelines emphasize that for opioid emergencies, naloxone administration and rescue breathing are the priority bystander interventions alongside activating 911.

How should a single rescuer prioritize interventions when alone with an unresponsive opioid overdose victim who has no normal breathing but has a pulse?

Answer: Call 911, give rescue breaths, and administer naloxone if available

The single rescuer should activate 911 first (or simultaneously), then prioritize rescue breathing to treat the respiratory arrest while administering available naloxone.

Naloxone is ineffective for reversing overdose caused by which of the following substances?

Answer: Benzodiazepines

Naloxone only blocks opioid receptors and has no effect on benzodiazepine-induced CNS/respiratory depression; those require supportive care or specific benzodiazepine antagonists.

Which statement correctly describes intramuscular (IM) naloxone compared to intranasal (IN) naloxone?

Answer: IM naloxone is absorbed more reliably when peripheral circulation is poor

IM injection delivers naloxone directly into muscle tissue with good bioavailability even in low perfusion states, while IN absorption depends on nasal mucosa integrity and blood flow.

After successfully reversing an opioid overdose with naloxone, the victim should be monitored for at least how long before being left unsupervised?

Answer: At least 1 hour, ideally until EMS evaluates the patient

Because naloxone wears off in 30–90 minutes and re-sedation can occur, the victim must be continuously monitored, ideally until EMS arrives and assumes care.