Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. Explore these free sample topics:
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First Things First (assess & treat for the following)
- Manage the ABCs.
- Primary manifestations of opiate toxicity: respiratory depression & depressed mental status
- Aggressive airway mgt is indicated in a pt who cannot maintain airway protection.
- Attempt naloxone to reverse toxicity – may give IV, IM, sub Q, via ETT (at 2.5-3 times IV dose diluted in 10 ml NS), but not PO.
- Attempt to use lowest effective dose to avoid precipitating opioid withdrawal.
- Start w/ 0.1 mg naloxone IV, then increase stepwise if ineffective (ie, 0.1 mg, then 0.4 mg, then 2 mg, and finally 10 mg).
- Depressed mentation/respiration persisting after 10 mg of IV naloxone is likely not related to opioid toxicity.
- Caution: Naloxone’s clinical duration of action is 20-90 min & many opiates have a longer duration of action (especially in the overdose setting). Thus, respiratory depression may recur & pt will need to be redosed or started on a naloxone infusion (see “Specific Treatment” section).
- Naloxone is typically very safe. Paramedics are allowed to administer naloxone (as well as glucose) without an MD order in many states.
- GI decontamination
- If route of ingestion was oral & time of ingestion was within the past 60 min, then gastric lavage may be beneficial.
- Activated charcoal (1 g/kg PO or per NG/lavage tube) is effective in adsorbing opioids within gut lumen in oral overdoses.
- Ensure that airway will be continuously protected before initiating gastric lavage or administering activated charcoal.