BLS Opioid-Associated Emergencies & Naloxone — Questions and Answers
Question 1: Which triad of signs is classically associated with opioid overdose?
- Hyperthermia, agitation, and dilated pupils
- Pinpoint pupils, unconsciousness, and respiratory depression (Correct answer)
- Bradycardia, hypertension, and seizures
- Flushed skin, vomiting, and tachycardia
Correct 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.
Question 2: What is the primary BLS intervention for an unresponsive victim of suspected opioid overdose who is not breathing normally?
- Administer naloxone before starting CPR
- Begin high-quality CPR immediately
- Give rescue breaths only and monitor for pulse (Correct answer)
- Place in recovery position and call 911
Correct 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.
Question 3: Naloxone (Narcan) works by:
- Stimulating the respiratory center in the brainstem directly
- Binding to opioid receptors and reversing opioid effects (Correct answer)
- Increasing heart rate to compensate for opioid-induced bradycardia
- Metabolizing opioids in the bloodstream
Correct 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.
Question 4: What is the recommended initial intranasal dose of naloxone for an adult opioid emergency in the community setting?
- 0.1 mg
- 0.4 mg
- 2 mg (Correct answer)
- 10 mg
Correct answer: 2 mg
Current AHA guidelines recommend 2 mg intranasal naloxone as the standard community dose for opioid-associated emergencies in adults.
Question 5: After giving naloxone to a victim of opioid overdose, if there is no response after 2–3 minutes, you should:
- Wait 10 minutes before giving a second dose
- Give an additional dose of naloxone (Correct answer)
- Stop all interventions as opioids are not the cause
- Administer epinephrine instead
Correct 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.
Question 6: Why is it critical to call 911 even if a victim responds well to naloxone?
- Naloxone causes dangerous rebound hypertension requiring hospital monitoring
- Naloxone has a shorter duration of action than most opioids, so overdose can recur (Correct answer)
- The victim must receive IV fluids after every naloxone administration
- Naloxone is only a temporary sedative, not a true antidote
Correct 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.
Question 7: Which route of naloxone administration is most commonly available to bystanders and trained lay rescuers?
- Intravenous (IV)
- Intramuscular (IM) with a syringe kit
- Intranasal (IN) spray device (Correct answer)
- Sublingual tablet
Correct 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.
Question 8: Opioid-associated cardiac arrest is best described as primarily:
- A shockable rhythm requiring early defibrillation
- A hypoxic arrest preceded by respiratory failure (Correct answer)
- A result of direct opioid cardiotoxicity
- A vagally mediated bradyasystolic arrest
Correct 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.
Question 9: 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?
- Wait for EMS arrival without intervening
- Begin chest compressions immediately
- Administer naloxone and give rescue breaths (Correct answer)
- Place in recovery position and monitor
Correct 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.
Question 10: The 2020 AHA BLS guidelines recommend that rescuers in non-medical settings who witness opioid overdose should:
- Perform CPR before calling 911 for 5 minutes
- Administer naloxone and provide rescue breathing as key interventions (Correct answer)
- Use AED first since opioids cause arrhythmias
- Only call 911 and do not intervene until EMS arrives
Correct 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.
Question 11: How should a single rescuer prioritize interventions when alone with an unresponsive opioid overdose victim who has no normal breathing but has a pulse?
- Begin CPR immediately in case of cardiac arrest
- Call 911, give rescue breaths, and administer naloxone if available (Correct answer)
- Administer naloxone, then call 911 only if no response
- Give 5 rescue breaths, then leave to call 911
Correct 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.
Question 12: Naloxone is ineffective for reversing overdose caused by which of the following substances?
- Heroin
- Oxycodone
- Benzodiazepines (Correct answer)
- Methadone
Correct 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.
Question 13: Which statement correctly describes intramuscular (IM) naloxone compared to intranasal (IN) naloxone?
- IM has slower onset than IN naloxone
- IM naloxone is absorbed more reliably when peripheral circulation is poor (Correct answer)
- IN naloxone requires a prescription while IM is available over the counter
- IM naloxone lasts twice as long as IN naloxone
Correct 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.
Question 14: After successfully reversing an opioid overdose with naloxone, the victim should be monitored for at least how long before being left unsupervised?
- 10–15 minutes
- 30 minutes
- At least 1 hour, ideally until EMS evaluates the patient (Correct answer)
- 4–6 hours in all cases
Correct 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.
