BLS Opioid-Associated Emergencies & Naloxone 2 — Questions and Answers
Question 1: A person is found unresponsive with slow, gurgling respirations of 4 breaths per minute. You suspect opioid overdose. What is the FIRST action?
- Administer naloxone immediately without any other assessment
- Activate the emergency response system (call 911) and get naloxone if available (Correct answer)
- Begin chest compressions at 100–120 per minute
- Perform a sternal rub to stimulate the patient
Correct answer: Activate the emergency response system (call 911) and get naloxone if available
The first step is to activate 911 to ensure advanced help is coming, then retrieve naloxone and begin rescue breathing as the priority intervention.
Question 2: Stimulation (sternal rub or calling the victim's name) is performed on a suspected opioid overdose victim because:
- Stimulation can reverse opioid effects like naloxone
- A person who responds to stimulation may not yet need naloxone (Correct answer)
- It activates the sympathetic nervous system, counteracting opioids
- Stimulation helps open the airway
Correct answer: A person who responds to stimulation may not yet need naloxone
If the victim responds to stimulation and begins breathing adequately, naloxone may not be immediately necessary, avoiding precipitation of acute opioid withdrawal.
Question 3: Which of the following opioids is most likely to require multiple doses of naloxone due to its potency?
- Codeine
- Hydrocodone
- Fentanyl (Correct answer)
- Tramadol
Correct answer: Fentanyl
Fentanyl and its analogues are 50–100 times more potent than morphine and often require repeated or higher doses of naloxone to fully reverse respiratory depression.
Question 4: When performing rescue breathing for an opioid overdose victim, the rescuer should give breaths at:
- 1 breath every 3 seconds (20 breaths/min)
- 1 breath every 5–6 seconds (10–12 breaths/min) (Correct answer)
- 1 breath every 10 seconds (6 breaths/min)
- 2 breaths every 30 chest compressions
Correct answer: 1 breath every 5–6 seconds (10–12 breaths/min)
For an adult with a pulse but absent or inadequate breathing, rescue breaths should be delivered at 1 breath every 5–6 seconds (10–12 breaths/min).
Question 5: After naloxone reversal, the victim becomes agitated and combative. This most likely indicates:
- An allergic reaction to naloxone
- Acute opioid withdrawal precipitated by naloxone (Correct answer)
- Re-sedation from the opioid
- Hypoglycemia unrelated to opioids
Correct answer: Acute opioid withdrawal precipitated by naloxone
Naloxone rapidly precipitates opioid withdrawal in dependent individuals, causing agitation, diaphoresis, nausea, vomiting, and combativeness.
Question 6: In an opioid overdose scenario where the victim has no pulse and no breathing, the rescuer should:
- Give naloxone only and wait for the pulse to return
- Begin CPR (30:2 compressions and ventilations) and administer naloxone (Correct answer)
- Perform rescue breathing only, as cardiac arrest is unlikely
- Use an AED first before starting CPR
Correct answer: Begin CPR (30:2 compressions and ventilations) and administer naloxone
If the victim is pulseless, standard high-quality CPR should begin immediately; naloxone can be administered concurrently but does not replace CPR.
Question 7: Which statement about community naloxone distribution programs is CORRECT?
- Naloxone can only be dispensed by physicians
- Lay persons trained in naloxone use have been shown to reduce opioid overdose deaths (Correct answer)
- Naloxone distribution increases illicit opioid use in communities
- Naloxone is only effective when given within 5 minutes of opioid ingestion
Correct answer: Lay persons trained in naloxone use have been shown to reduce opioid overdose deaths
Research consistently shows that community naloxone distribution and training programs significantly reduce opioid overdose mortality without increasing drug use.
BLS Opioid-Associated Emergencies & Naloxone 2
A person is found unresponsive with slow, gurgling respirations of 4 breaths per minute.
You suspect opioid overdose.
What is the FIRST action?