Understanding the Emergency Algorithm for Opioid Overdose
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Article at a Glance
- A sign a victim is experiencing an opioid overdose is paraphernalia at the scene. The situation can be dangerous, so make your safety a priority. Opioids are potent CNS depressants leading to hypoxia and cardiac arrest.
- Treatment begins by opening the airway, providing oxygenated ventilations, and administering Narcan.
- The recommended starting dose of Narcan is 2 mg intranasally or 0.4 mg IV.
- Proceed with treatment like a standard cardiac arrest but with the administration of Narcan.
Opioid-Associated Emergency Algorithm
It’s important to understand the opioid-associated emergency algorithm. Providers have had to increasingly rely on it as America’s opioid epidemic has grown. It’s paramount that you know proper treatment protocols.
This lesson reviews the opioid-associated emergency algorithm.
ACLS Opioid Arrest Algorithm
Background
Remember to first ensure your safety when entering a situation with a potential heroin overdose or cardiac arrest. It can be a dangerous situation. Indicators of overdose are drug paraphernalia at the scene such as a needle hanging out of the arm or nearby. Also, others in the room may also be intoxicated on heroin.
People die from heroin overdose because they stop breathing. Heroin, opioids, and narcotics are all potent respiratory and central nervous system depressants.
The main cause of death during an opioid overdose is the cessation of breathing.
Read: General Stroke Care
Treatment
A patient who overdoses on opioids is unconscious, and they’ll breathe less often and with less tidal volume. They may become hypoxic. They’ll develop an arrhythmia leading to a cardiac arrest. We want to ensure this doesn’t happen.
The best initial treatment is to open the airway and provide ventilations with 100% oxygen as you quickly administer the opioid reversal agent. The reversal agent, or opioid antagonist, is called Narcan (Naloxone).
There is no specific reversal dose since we don’t know how much heroin the patient took. The recommended starting dose is 2 mg intranasal or 0.4 mg IM. Intranasal is a popular administration route because it doesn’t involve needles and can be administered quickly.
Naloxone (Narcan) is an opioid antagonist, the reversal agent for opioids.
Cardiac Arrest Following an Opioid Overdose
Let’s say that you’ve arrived at the scene and the patient experiencing an opioid overdose is in cardiac arrest. Basically, you’re working a standard cardiac arrest, except with adding Narcan administration into the treatment.
Step 1
First, establish unresponsiveness. Call 9-1-1 because you’ll need more professional help. You’ll also need a reversal agent.
Step 2
If the patient does not have a pulse, begin chest compressions immediately. Operate the same as a standard cardiac arrest, so apply the AED and defibrillate as needed.
Step 3
Administer Narcan as soon as it is available. The dosing is 2mg intranasal or 0.4 mg IM.
Step 4
Again, determine if the patient is responsive. The first dose of Narcan may reverse the overdose. However, the patient may wake up and become unresponsive again.
Step 5
It’s paramount to constantly monitor the patient. Pay close attention to the pulse oximetry, cardiac monitor, and end-tidal monitoring. You may have to re-administer Narcan, and some patients may require a Narcan drip when they get to the hospital if they’ve taken large amounts of heroin.
Step 6
If the patient remains unresponsive, administer CPR and use the AED as soon as it is available.
Summary
If the patient lacks a pulse and is not breathing, treat them as a standard cardiac arrest with the addition of Narcan administration. If the patient has a pulse and you suspect an opioid narcotic overdose, open the patient’s airway, begin bagging, and immediately administer Narcan.
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Editorial Note
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