BLS for Opioid Overdose

With the rise of opioid-related emergencies, healthcare providers must be prepared to recognize and treat opioid-induced respiratory depression and cardiac arrest. Prompt intervention with rescue breathing, high-quality CPR, and naloxone administration can be life-saving.

Recognizing Opioid Overdose

Opioid overdoses often lead to respiratory arrest before cardiac arrest. Early recognition and intervention can prevent full cardiac arrest.

Key Signs of Opioid Overdose:

• Unresponsiveness to voice or pain stimulus.
• Slow, irregular, or absent breathing (respiratory depression).
• Pinpoint pupils (miosis), a hallmark of opioid overdose.
• Cyanosis (bluish skin, lips, or fingertips due to lack of oxygen).
• Bradycardia (slow heart rate) leading to cardiac arrest if untreated.

How to Manage an Opioid Overdose Emergency

1. Assess the Patient

• Check for responsiveness by tapping and shouting.
• If unresponsive, check for breathing and pulse for no more than 10 seconds.
• If the patient has a pulse but is not breathing, begin rescue breathing.
• If the patient has no pulse, start CPR immediately.

2. Provide Rescue Breathing (If Pulse Is Present)

• Ventilate at a rate of 1 breath every 5-6 seconds (~10-12 breaths per minute).
• Use a bag-mask device (BVM) if available.
• Ensure each breath lasts 1 second and produces visible chest rise.

3. Perform High-Quality CPR (If No Pulse)

• Start chest compressions at 100-120 per minute.
• Compression depth: At least 2 inches (5 cm) in adults.
• Minimize interruptions and allow for full chest recoil.
• Provide a 30:2 compression-to-ventilation ratio (single rescuer).

4. Administer Naloxone (Narcan)

Naloxone is an opioid antagonist that reverses respiratory depression and opioid toxicity.

Naloxone Administration Routes:

• Intranasal (IN): 2-4 mg per spray, repeated every 2-3 minutes as needed.
• Intramuscular (IM): 0.4-2 mg, repeated every 2-3 minutes as needed.
• Intravenous (IV): 0.4 mg bolus, titrated as needed.

Key Considerations When Administering Naloxone:

• If the patient remains unresponsive after 2 doses, continue CPR and ventilation—opioid overdose may not be the only cause of arrest.
• Be prepared for opioid withdrawal symptoms (agitation, vomiting, increased heart rate) if the patient regains consciousness.
• Naloxone has a shorter half-life than most opioids—continuous monitoring is essential to prevent relapse into respiratory depression.

Key Takeaways: BLS for Opioid Overdose

• Recognize slow breathing, pinpoint pupils, and unresponsiveness as key signs of opioid overdose.
• If a pulse is present but breathing is inadequate, provide rescue breaths.
• If no pulse, start CPR immediately and apply an AED.
• Administer naloxone as soon as possible and be prepared to repeat doses.
• Monitor for recurring respiratory depression due to naloxone’s shorter half-life.

Effective intervention in opioid overdose cases requires quick recognition, high-quality CPR, and timely naloxone administration.

This concludes the special populations section of HCP BLS. Next, we’ll finalize the course with a recap and exam preparation.