BLS Opioid-Associated Emergencies & Naloxone 1 — 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.
BLS Opioid-Associated Emergencies & Naloxone 1
Which triad of signs is classically associated with opioid overdose?