6.3 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)
• Cyanosis (bluish lips, skin, or fingertips)
• Bradycardia (slow heart rate) leading to cardiac arrest if untreated

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)

• 1 breath every 5–6 seconds (~10–12 breaths per minute)
• Use a bag-mask device (BVM) if available
• Each breath should last 1 second and result in visible chest rise

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

• Compression rate: 100–120 per minute
• Depth: at least 2 inches (5 cm) in adults
• Minimize interruptions; allow full chest recoil
• Use a 30:2 compression-to-ventilation ratio for single-rescuer CPR

4. Administer Naloxone (Narcan)

Naloxone is an opioid antagonist that can reverse respiratory depression and opioid toxicity.

Naloxone Administration Routes

• Intranasal (IN):
  ×

  Intranasal (IN):

  

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  2–4 mg per spray, repeat every 2–3 minutes as needed
• Intramuscular (IM):
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  Intramuscular (IM):

  

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  0.4–2 mg, repeat every 2–3 minutes as needed
• Intravenous (IV): 0.4 mg bolus, titrated to effect

Key Considerations

• If the patient remains unresponsive after 2 doses, continue CPR—opioid overdose may not be the only cause
• Be prepared for withdrawal symptoms if the patient regains consciousness
• Naloxone has a shorter half-life than most opioids—monitor for return of symptoms

Key Takeaways

• Recognize slow breathing, pinpoint pupils, and unresponsiveness
• Provide rescue breathing if the patient has a pulse but is not breathing
• Begin CPR immediately if no pulse is present
• Administer naloxone promptly, and repeat doses as needed
• Monitor closely for recurrent respiratory depression

This concludes the Special Populations section of the HCP BLS course. Up next: a full course recap and certification exam prep.