A fictional 43-year-old is found drowsy with slow, shallow breathing and pinpoint pupils beside prescribed and non-prescribed medicines.
Frame the danger first.
- Treat slow, irregular or absent breathing with reduced responsiveness as an immediate threat.
- Opioid toxicity is a clinical diagnosis; pinpoint pupils support but do not prove it.
- Consider co-ingestion, hypoglycaemia, head injury and other causes of reduced consciousness.
Act, escalate, reassess.
- Call emergency help, open the airway and support ventilation using an ABCDE approach.
- Follow the current Resuscitation Council UK and local naloxone pathway if opioid overdose is suspected.
- Check glucose, obtain focused collateral information and assess for co-ingestants without delaying respiratory support.
- Continue close observation because toxicity can recur after an initial response.
Red flags that change pace.
- Apnoea, cyanosis, severe hypoxaemia or cardiac arrest
- Recurrent respiratory depression or suspected long-acting opioid exposure
- Mixed overdose, aspiration, trauma or persistent altered consciousness
What makes care less safe.
- Waiting for laboratory confirmation before supporting breathing
- Using arousal alone rather than ventilation as the treatment goal
- Discharging after a brief response without accounting for recurrent toxicity
Say the concern plainly.
Suspected opioid toxicity with respiratory rate [result], oxygenation [result] and consciousness [summary]. Airway/ventilation support and naloxone response are [details]. Possible substances and co-ingestants are [known/unknown]; ongoing monitored care is required.