Management of Opioid Analgesic Overdose
N Engl J Med 2012;367:146-55
Clinical Manifestations
The classic toxidrome of apnea, stupor, and miosis suggests the diagnosis of opioid toxicity
Diagnosis
Physical examination (hypopnea or apnea, miosis, and stupor) should lead the clinician to consider the diagnosis of opioid analgesic overdose.
Quantitative measures of drug concentrations are useless in cases of overdose.
Management
Patients with apnea need a pharmacologic or mechanical stimulus in order to breathe.
Naloxone
- onset <2 minutes (IV)
- duration 20 to 90 minutes
- Once the respiratory rate improves after the administration of naloxone, the patient should be observed for 4 to 6 hours before discharge is considered.
Decision Tree for Managing Opioid Analgesic Overdose in Adults.
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