Opioid Overdose- EPICC referral

Symptoms

• exhibiting miosis (pinpoint pupils)
• decreased mental status
• respiratory depression

Clinical Management Options

EMT-B

• Place in position of comfort • Oxygen target SpO2 92% – 96%   • Automatic intranasal Narcan • Consider referring patients to EPIC for opioid treatment • EMS referral can call 314-819-4275 • The patient can call 314-469-6644 at anytime for referral

Paramedic

• IV / IO access as appropriate for patient condition  • Naloxone

Pearls

• The treatment for opioid overdose is respiratory support; the antidote is naloxone. The BVM is more important/should come before antidote administration
• Smaller doses of naloxone can be used to help the patient breathe without putting the patient into acute withdrawal
  • This can be especially important to consider in patients who have mixed ingestions
• Patients who are enrolled in medication assisted treatment (MAT) can have successful treatment of their opioid use disorder. 
• Some patients have pulmonary edema with poor oxygenation after opioid overdose and naloxone administration. 
• Some patients with pontine strokes present very similar to opioid overdoses (pinpoint pupil, sonorous respirations, unresponsiveness). Consider other causes in patients who are unresponsive to Narcan; consider transport to a stroke center if there is concern for a pontine stroke.
• Narcan is not indicated in adult medical cardiac arrests.
• Hotline pediatric patients who are in the home of patients requiring Narcan.